COMMUNITY LEADERSHIP 2.0 - Application (2027) Survey

Question Title

1. By signing my full name and dating below, I confirm that the information I provide hereafter is accurate and true. (Required.)

PERSONAL INFORMATION

Question Title

2. First Name (Required.)

Question Title

3. Last Name (Required.)

Question Title

4. E-mail address (Required.)

Question Title

5. What is your home street address? (Required.)

Question Title

6. What is your city, state, zip? (Required.)

Question Title

7. Mobile Phone Number (Required.)

Question Title

8. Preferred Contact Phone Number (if different from mobile number provided above)

Question Title

9. Date of birth (Required.)

Date (MM/DD/YYYY)

Date

Question Title

10. What is your gender identity? (Required.)

Male

Female

Non-binary

Prefer not to answer

Prefer to self-describe:

Question Title

11. Race (Required.)

American Indian or Alaska Native

Asian or Pacific Islander

Black or African American

Hispanic or Latino

White/Caucasian

Prefer not to answer

Prefer to self-describe

Question Title

12. Name of the local community leadership development program(s) in which you have participated. Completion of a local community leadership development program or comparable experience is a prerequisite of Community Leadership 2.0 participation. (Required.)

Question Title

13. Tuition for participants in the Community Leadership 2.0 cohort model is $1950. How do you plan to cover the cost of tuition?

Question Title

14. Scholarships may be available for qualified applicants who demonstrate a strong commitment to the program and who may need financial assistance to participate. Would you need scholarship funds in order to participate?

Yes

Question Title

15. If you are requesting scholarship funds, please describe your need.

Question Title

16. Special Requirements: dietary, physical or other

EDUCATIONAL BACKGROUND

Question Title

17. Post-Secondary School

Question Title

18. Graduate School - School and Area of Study

EMPLOYMENT INFORMATION

Question Title

19. Current Employer (company/organization) (Required.)

Question Title

20. Employer Address (Street, City, State, Zip) (Required.)

Question Title

21. Length of time employed by current employer (Required.)

Question Title

22. Name of Immediate Supervisor (Required.)

Question Title

23. Email Address of Immediate Supervisor (Required.)

Question Title

24. Phone Number of Immediate Supervisor (Required.)

Question Title

25. I hereby verify that my immediate supervisor and/or employer have received information about the requirements of participation in Community Leadership 2.0 and support my participation in the program.
Please sign and date below to confirm the above statement. (Required.)

Question Title

26. Previous employers since 2020, if any

PROFESSIONAL & COMMUNITY ENGAGEMENT

Question Title

27. Please list all business and/or professional affiliations.

Include name of organization(s), position(s) held, period of affiliation, and description of involvement.

Question Title

28. Please list all community involvement here (community, civic, religious, political, social, athletic, or other activities).

Include name of organization(s), position(s) held, period of affiliation, and description of involvement.

LEADERSHIP DEVELOPMENT REFERENCE

Question Title

29. Name of nominator or reference who could speak to the demonstration of your leadership capacity. (Required.)

Question Title

30. Relationship to Nominee (Required.)

Question Title

31. Nominator/Reference Email Address (Required.)

Question Title

32. Nominator/Reference Contact Phone Number (Required.)

Question Title

33. How did you learn about Community Leadership 2.0?

ESSAY QUESTIONS

Please share your answer to the following questions in no more than 250 words per question.

Question Title

34. In your opinion, what are the most critical issues facing the state of Wisconsin? (Required.)

Question Title

35. We strive to develop a diverse class that is comprised of a variety of different leaders. Please describe what makes you a compelling candidate for Community Leadership 2.0 and tell us why you want to participate in the program. Consider how your unique blend of personality, skills, perspectives, and experiences - both professionally and in the community - would make you an asset to the program and the cohort. (Required.)

Question Title

36. What do you most wish to obtain from the Community Leadership 2.0 experience? (Required.)

Question Title

37. What, if any, connection do you have to the focus topic for this year's Community Leadership 2.0 cohort - Housing? (Required.)

Question Title

38. What aspirations do you have for yourself in terms of future community leadership roles and impact? (Required.)

Question Title

39. Please choose one of the following questions to answer:

What factors (positive or negative) have influenced your growth as a leader?

Every obstacle we face in life comes with an opportunity to learn something new. Describe a challenge you have faced, how you persevered, and what you learned from the experience.

Tell us about a person who has been a leadership role model for you and why they have impacted your leadership journey.

Question response:

COMMUNITY LEADERSHIP 2.0 - Application (2027)

Question Title

* 1. By signing my full name and dating below, I confirm that the information I provide hereafter is accurate and true. (Required.)

Question Title

* 2. First Name (Required.)

Question Title

* 3. Last Name (Required.)

Question Title

* 4. E-mail address (Required.)

Question Title

* 5. What is your home street address? (Required.)

Question Title

* 6. What is your city, state, zip? (Required.)

Question Title

* 7. Mobile Phone Number (Required.)

Question Title

* 8. Preferred Contact Phone Number (if different from mobile number provided above)

Question Title

* 9. Date of birth (Required.)

Question Title

* 10. What is your gender identity? (Required.)

Question Title

* 11. Race (Required.)

Question Title

* 12. Name of the local community leadership development program(s) in which you have participated. Completion of a local community leadership development program or comparable experience is a prerequisite of Community Leadership 2.0 participation. (Required.)

Question Title

* 13. Tuition for participants in the Community Leadership 2.0 cohort model is $1950. How do you plan to cover the cost of tuition?

Question Title

* 14. Scholarships may be available for qualified applicants who demonstrate a strong commitment to the program and who may need financial assistance to participate. Would you need scholarship funds in order to participate?

Question Title

* 15. If you are requesting scholarship funds, please describe your need.

Question Title

* 16. Special Requirements: dietary, physical or other

Question Title

* 17. Post-Secondary School

Question Title

* 18. Graduate School - School and Area of Study

Question Title

* 19. Current Employer (company/organization) (Required.)

Question Title

* 20. Employer Address (Street, City, State, Zip) (Required.)

Question Title

* 21. Length of time employed by current employer (Required.)

Question Title

* 22. Name of Immediate Supervisor (Required.)

Question Title

* 23. Email Address of Immediate Supervisor (Required.)

Question Title

* 24. Phone Number of Immediate Supervisor (Required.)

Question Title

* 25. I hereby verify that my immediate supervisor and/or employer have received information about the requirements of participation in Community Leadership 2.0 and support my participation in the program.Please sign and date below to confirm the above statement. (Required.)

Question Title

* 26. Previous employers since 2020, if any

Question Title

* 27. Please list all business and/or professional affiliations.Include name of organization(s), position(s) held, period of affiliation, and description of involvement.

Question Title

* 28. Please list all community involvement here (community, civic, religious, political, social, athletic, or other activities).Include name of organization(s), position(s) held, period of affiliation, and description of involvement.

Question Title

* 29. Name of nominator or reference who could speak to the demonstration of your leadership capacity. (Required.)

Question Title

* 30. Relationship to Nominee (Required.)

Question Title

* 31. Nominator/Reference Email Address (Required.)

Question Title

* 32. Nominator/Reference Contact Phone Number (Required.)

Question Title

* 33. How did you learn about Community Leadership 2.0?

Question Title

* 34. In your opinion, what are the most critical issues facing the state of Wisconsin? (Required.)

Question Title

Question Title

* 36. What do you most wish to obtain from the Community Leadership 2.0 experience? (Required.)

Question Title

* 37. What, if any, connection do you have to the focus topic for this year's Community Leadership 2.0 cohort - Housing? (Required.)

Question Title

* 38. What aspirations do you have for yourself in terms of future community leadership roles and impact? (Required.)

Question Title

* 39. Please choose one of the following questions to answer:

Question Title

* 40. Your Title/Job/Role (Required.)

1. By signing my full name and dating below, I confirm that the information I provide hereafter is accurate and true. (Required.)

2. First Name (Required.)

3. Last Name (Required.)

4. E-mail address (Required.)

5. What is your home street address? (Required.)

6. What is your city, state, zip? (Required.)

7. Mobile Phone Number (Required.)

8. Preferred Contact Phone Number (if different from mobile number provided above)

9. Date of birth (Required.)

10. What is your gender identity? (Required.)

11. Race (Required.)

12. Name of the local community leadership development program(s) in which you have participated. Completion of a local community leadership development program or comparable experience is a prerequisite of Community Leadership 2.0 participation. (Required.)

13. Tuition for participants in the Community Leadership 2.0 cohort model is $1950. How do you plan to cover the cost of tuition?

14. Scholarships may be available for qualified applicants who demonstrate a strong commitment to the program and who may need financial assistance to participate. Would you need scholarship funds in order to participate?

15. If you are requesting scholarship funds, please describe your need.

16. Special Requirements: dietary, physical or other

17. Post-Secondary School

18. Graduate School - School and Area of Study

19. Current Employer (company/organization) (Required.)

20. Employer Address (Street, City, State, Zip) (Required.)

21. Length of time employed by current employer (Required.)

22. Name of Immediate Supervisor (Required.)

23. Email Address of Immediate Supervisor (Required.)

24. Phone Number of Immediate Supervisor (Required.)

25. I hereby verify that my immediate supervisor and/or employer have received information about the requirements of participation in Community Leadership 2.0 and support my participation in the program.
Please sign and date below to confirm the above statement. (Required.)

26. Previous employers since 2020, if any

27. Please list all business and/or professional affiliations.

Include name of organization(s), position(s) held, period of affiliation, and description of involvement.

28. Please list all community involvement here (community, civic, religious, political, social, athletic, or other activities).

Include name of organization(s), position(s) held, period of affiliation, and description of involvement.

29. Name of nominator or reference who could speak to the demonstration of your leadership capacity. (Required.)

30. Relationship to Nominee (Required.)

31. Nominator/Reference Email Address (Required.)

32. Nominator/Reference Contact Phone Number (Required.)

33. How did you learn about Community Leadership 2.0?

34. In your opinion, what are the most critical issues facing the state of Wisconsin? (Required.)

36. What do you most wish to obtain from the Community Leadership 2.0 experience? (Required.)

37. What, if any, connection do you have to the focus topic for this year's Community Leadership 2.0 cohort - Housing? (Required.)

38. What aspirations do you have for yourself in terms of future community leadership roles and impact? (Required.)

39. Please choose one of the following questions to answer:

40. Your Title/Job/Role (Required.)