1.What is your name? 

2.What is your current jurisdiction?

3.What is your job title?

4.What is your phone number?

5.What is your e-mail address?

6.I understand that the CLG Leadership Academy will only accept one person per government in the first round of applications, ending on Friday, February 27th. In the event there are multiple individuals from your community and we cannot fit all of you, we will ask your community's CAO to decide who attends this year.

Yes

No

7.Do you commit to attending all of the Leadership Academy Classes? 

(Exceptions can be made in certain circumstances.  It is the responsibility of the attendee to identify an appropriate make-up class -per the approval of the Leadership Academy planning committee).

Yes

No

8.The Leadership Academy brochure provided you with three options for a one-day class from Xavier University- Fostering Teamwork and Trust on May 13th, Effective Decision Making on May 20th, or Strengths-Based Leadership on May 27th. Please state below which of these three classes you would rather attend. Please be advised that we can accept 10 people per class, and they will fill on a first come first served basis.

Fostering Teamwork and Trust (May 13)

Effective Decision Making (May 20)

Strenghts-Based Leadership (May 27)

9.Please briefly describe your work history

10.Briefly describe why you are interested in attending the Center for Local Government Leadership Academy.

11.I understand that I need my Chief Administrative Officer to sign a Chief Administrative Officer Authorization Form (available at https://www.c4lg.org/leadership-academy/) for me to attend the CLG Leadership Academy.

Yes

No

12.I understand that the tuition for this year's Academy will be $1,120 per person. Please note this number may go down if grant money is obtained.

Yes

No