Program Application Form

Click here to view or download your Leadership Cattaraugus Applicaton Form.

Personal Data:

Name:
Title:
Place of Employment:
Business Mailing Address:
City State Zip
Business Phone:
Business E-Mail:
Home Mailing Address:
City State Zip
Home Phone:
Home E-mail:

Have you previously applied for Leadership Cattaraugus? Yes No
What year(s)?
How did you learn about Leadership Cattaraugus (please be as specific as possible)?
Years living and/or working in Cattaraugus County?

EMPLOYMENT Employment:

Present title:

Present employer:

Current job responsibilities:

List up to 3 previous positions of employment:

Employer	Title/Responsibility	From	To

Education
Please list in descending order any higher education you received (post high school.)

School Name	Major	Degree (If Obtained)

Training

Please list any significant training or certification you have received in the last 5 years.

Community Involvement

Please list activities outside of your employment that you have been involved in within the past five years. Examples may include community, cultural, athletic, social, religious, etc. Please describe the role you played in furthering the mission of these organizations.

Most Notable Accomplishment(s) At one time -- in your career, as a member of a team or organization, or in a community or volunterr group -- you made something happen that would not have occurred without your leadership. Write a brief description of that experience and what has been the measurable result(s) or important lesson(s) learned from your effort. Additional Information 1. Please list what you believe to be the best assets or advantages of living or working in Cattaraugus County:
2. Please list what you believe to be the most significant problems of living or working in Cattaraugus County:
3. How do you think you could contribute to the solution of these problems?
4. What is your definition of a leader?

References

List two professional or personal references. The Selection Committee may contact your references.

Name	Title / Organization	Phone

COMMITMENT

ATTENDANCE/PARTICIPATION: Full attendance at all sessions is required. Attendance at the entire opening retreat is mandatory for participation in the Leadership Cattaraugus program.

TUITION: Tuition is $1200. Tuition is non-refundable. Unless special arrangements have been made with the executive director and aproved by the Leadership Cattaraugus Board of Directors, tuition must be received in full prior to the opening retreat. Candidates are expected to secure their own financial sponsors.

SCHOLARSHIPS: A limited number of PARTIAL tuition discounts are available and are determined by need. Candidates wishing to apply for tuition assistance must complete the separate Application for Tuition Discount form, available from the Leadership Cattaraugus office or from our website, and submit it with their application.

There is a $25.00 processing fee which can be made payable to Leadership Cattaraugus, Inc.

Mail Check to:

Leadership Cattaraugus
P.O. BOX 176
Olean, NY 14670