Early Childhood Leaders of Influence Cohort

APPLICATION

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* 1. First and Last Name

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* 2. Email Address

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* 3. Address

Street:

City & State

Zip Code

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* 4. Phone

Cell:

Work:

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* 5. Employer

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* 6. Program Type:

Child Care Center

Early Head Start/Head Start

Public Preschool

Family Child Care

School-Age Child Care

Resource and Referral

Other (please specify)

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* 7. Program Recognition

NAEYC Accreditation

NAFCC Accreditation

SUTQ 3-5 Star

SUTQ: 1-2 Star

None of the above

Other (please specify)

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* 8. Current Professional Role

Director/Owner/CEO

Assistant Director

Coordinator/Program Specialist

Lead Teacher

Assistant Teacher

Other (please specify)

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* 9. Please specify your ethnicity. This will assist in outreach to under-represented groups.

White

Black or African American

Hispanic

Asian / Pacific Islander

Prefer not to answer.

Other (please specify)

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* 10. I have served in a leadership role for

Less than one year

1-5 Years

5-10 years

10 years+

I plan to seek a leadership role in the future

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* 11. Please share why you should be selected to participate in the leadership cohort. Your response should include how you demonstrate passion, commitment and a solution-oriented mindset and your willingness to step forward to serve and advocate on behalf of the early childhood profession.

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* 12. Please describe your greatest leadership challenge.

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* 13. Please describe your greatest strengths.

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* 14. Where do you envision yourself professionally 3-5 years from now?

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* 15. What interests you most about this leadership opportunity?

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* 16. Tell us something about yourself that will bring diversity to our Leadership Cohort.

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* 17. Please upload a copy of your resume.

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

Choose File

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* 18. Please upload a copy of Reference Letter #1. Reference letters should be specific as to why you should be selected to participate in the leadership cohort. The reference should include how you have demonstrated passion, commitment and a solution-oriented mindset and your ability to step forward to serve and advocate on behalf of the early childhood profession.

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

Choose File

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* 19. Please upload a copy of Reference Letter #2. Reference letters should be specific as to why you should be selected to participate in the leadership cohort. The reference should include how you have demonstrated passion, commitment and a solution-oriented mindset and your ability to step forward to serve and advocate on behalf of the early childhood profession.

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

Choose File