LOANEDEXECUTIVE2016-17APPLICATION
PRESENTED BY
Full Name:
Nickname/PreferredName: _
Employer:
Position/Title:
Business Address:
Phone (W): _Fax(W):
Phone (C):
Email (W):
Supervisor:
Brieflydescribe your currentworkresponsibilities:
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Do you have priorLoanedExecutiveexperience (please circle)? Yes / No
Please list any previous non-profitexperience andpositions held(including UnitedWay):
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Whydoyou wanttobe apart of the LoanedExecutive Program?
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What personal qualities will make you a successful LE? _
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What do you want to get out of your involvement in the Loaned Executive Program? _
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What is something fun or unusual about you that you do not mind sharing with others? Special interests or talents? _
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Whatquestions or concerns doyouhave aboutbeing aUnitedWayLoanedExecutive?
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What areas of philanthropy interest you most (i.e. Children, Elderly, Developmentally Disabled, Homelessness, Health, Financial Stability, Education, Other)?
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ShirtSize (please circle one):SMLXL2X3X
Attendance Requirements and Program Agreement:
For the Loaned Executive Program to be truly meaningful, Loaned Executives have a responsibility to participate fully. Attendance at scheduled functions, as well as interaction among fellow LEs is essential to the total learning experience. For this reason, Loaned Executives must agree to the following attendance policy.
Loaned Executives will be required to volunteerapproximately 10 hours a month from February-December during normal business hours (8am-5pm). Attendance is expected for the Community Investment Process (February-May), is required for the Loaned Executive training session (July 13, 8am-5pm), and expected forthe Leadership Training sessions (usually held on the second Wednesday of the month, August-December from 8am-12pm).
To ensure the quality of the program for all participants, excessive absences will result in a dismissal from the Loaned Executive Program.
By signing below, I acknowledge understanding of the attendance requirements of the Loaned Executive Program.
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Supervisor/EmployerEndorsement
If the candidate on this application is selected to participate in United Way of Escambia County’s Loaned Executive Program, they will be required to volunteerapproximately 10 hours a month from February-December during normal business hours (8am-5pm). This commitment includes a required monthly training session (usually on the second Wednesday of the month) July-December from 8am-12pm. To learn more about specific requirements of the program, including time commitment, please visit or contact or 850-444-7147.
By signing below,I amindicatingthatI amauthorizedto endorsethefullparticipationofthiscandidate.I also understandthatifproperlyengaged,theLoaned Executivewillreceivevaluabletraining,publicspeakingexperience, networkingopportunities andleadershipskills.
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Return completed application to