Child & Family Leadership Exchange Application 2023-2024

Class XXVIII

Thank you for your interest in CFLE. Please complete each section of this confidential application in full. Note: Once you start the application it must be finished and submitted; there is no saving and editing at a later time.

This application is due no later than April 28th, 2023

Class participants will be chosen by the CFLE Advisory Committee based on leadership potential, community service, ability to comply with the time commitment required and the participants ability to utilize the skills gained through this program on a long-term basis to benefit our community. Appointments to each Class are limited.

Once selected, Class participants will commit to monthly sessions in addition to pre-class activities and a service project. Tuition is non-refundable and all applicants must have full, written support of the organization they represent.

Any questions please contact Kelly Aloisi, CFLE Program Coordinator at Kelly.Aloisi@summitkids.org

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* 1. Name

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* 2. Employer

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* 3. Job Title

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* 4. Professional Licences/Titles (PhD., LSW, etc.)

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* 5. Business Address

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* 6. Business Phone #

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* 7. Cell Phone #

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* 8. Email Address

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* 9. Home Address

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* 10. Where did you hear about CFLE?

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* 11. Education-High School

Name of School(s)

Date of Graduation

Major/Area of Study

Degree

Any additional information:

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* 12. Education-College/University (Undergraduate)

Name of School

Date of Graduation

Major/Area of Study

Degree

Any additional information:

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* 13. Education-College/University (Graduate/Advanced)

Name of School

Date of Graduation

Major/Area of Study

Degree

Any additional information:

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* 14. Awards/Honors/Offices/Extracurricular Activities while in School

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* 15. Current Employment

How long have you been in this position?

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* 16. Briefly describe your current employment responsibilities:

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* 17. Previous Employment #1

Name of Employer

Title(s)

Dates

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* 18. Previous Employment #2

Name of Employer

Title(s)

Dates

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* 19. Professional Affiliations

Name of Organization(s)

Position(s) Held

Dates

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* 20. Community Involvement

Name of Organization(s)

Position(s) Held

Additional Information:

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* 21. What do you consider to be your most important accomplishment in one of the above organizations?

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* 22. What particular strengths and experiences do you bring to the CFLE Program?

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* 23. Identify one problem related to Social Services facing Summit County residents and discuss an approach to solving it:

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* 24. Reference #1

Name and Title

Business/Organization

Phone #

Address

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* 25. Reference #2

Name and Title

Business/Organization

Phone #

Address

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* 26. Reference #3

Name and Title

Business/Organization

Phone #

Address

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* 27. Sponsoring Organizations Agreement:
This applicant has the full support of the below person/organization for the time commitment required to participate effectively in the Child & Family Leadership Exchange Program during the upcoming year.

Organization Name:

Director/CEO Name:

Phone or Email:

Date:

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* 28. Tuition Agreement:
If selected to participate in the CFLE program you or your sponsoring organization agree to pay the $950.00 non-refundable tuition fee no later than August 25th, 2023. The tuition covers the cost of this 11 month program including the overnight retreat and monthly sessions.
A limited number of scholarships may be available; please see additional questions on this application for information.

Yes- I and my organization accept the responsibility for the $950.00 tuition if I am chosen as a CFLE Class participant

I would like to apply for a scholarship at this time

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* 29. Scholarship Request:
A limited number of full/partial scholarships may be available. To be considered please explain below your agency's need for the assistance and how your agency will benefit from having a participant in the CFLE program.

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* 30. Attendance Agreement & Signature:
By entering your name below you are completing your application to become a member of the Child & Family Leadership Exchange Class XXVIII. You fully understand that attendance at monthly sessions are mandatory. Though emergencies do arise, class members missing more than 2 sessions may not graduate unless given the opportunity to make-up work/activities as determined and approved by the Session Chairs/Advisory Committee. Furthermore, you understand that upon acceptance into the program a written agreement complying with tuition and attendance requirements will be completed by you and your sponsoring agency/organization. You agree to all of the terms outlined in this application and are ready to take on a leadership role within this opportunity!

Name

Date

Child & Family Leadership Exchange Application 2023-2024

Class XXVIII

Question Title

* 1. Name

Question Title

* 2. Employer

Question Title

* 3. Job Title

Question Title

* 4. Professional Licences/Titles (PhD., LSW, etc.)

Question Title

* 5. Business Address

Question Title

* 6. Business Phone #

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* 7. Cell Phone #

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* 8. Email Address

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* 9. Home Address

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* 10. Where did you hear about CFLE?

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* 11. Education-High School

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* 12. Education-College/University (Undergraduate)

Question Title

* 13. Education-College/University (Graduate/Advanced)

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* 14. Awards/Honors/Offices/Extracurricular Activities while in School

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* 15. Current Employment

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* 16. Briefly describe your current employment responsibilities:

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* 17. Previous Employment #1

Question Title

* 18. Previous Employment #2

Question Title

* 19. Professional Affiliations

Question Title

* 20. Community Involvement

Question Title

* 21. What do you consider to be your most important accomplishment in one of the above organizations?

Question Title

* 22. What particular strengths and experiences do you bring to the CFLE Program?

Question Title

* 23. Identify one problem related to Social Services facing Summit County residents and discuss an approach to solving it:

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* 24. Reference #1

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* 25. Reference #2

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* 26. Reference #3

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* 27. Sponsoring Organizations Agreement: This applicant has the full support of the below person/organization for the time commitment required to participate effectively in the Child & Family Leadership Exchange Program during the upcoming year.

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* 29. Scholarship Request: A limited number of full/partial scholarships may be available. To be considered please explain below your agency's need for the assistance and how your agency will benefit from having a participant in the CFLE program.

Question Title

* 27. Sponsoring Organizations Agreement:
This applicant has the full support of the below person/organization for the time commitment required to participate effectively in the Child & Family Leadership Exchange Program during the upcoming year.

* 29. Scholarship Request:
A limited number of full/partial scholarships may be available. To be considered please explain below your agency's need for the assistance and how your agency will benefit from having a participant in the CFLE program.