Leadership Academy Application

Leadership Academy Application

Council on Student Affairs

Sponsoring Institution

Chief Student Affairs Officer

Name of Applicant

Last, First

Office Address

Street Address, City, Zip Code

Email

Office Phone () Cell Phone ()

Current Position How long?

Years

Education (degrees earned and awarding institution)

List other academic achievements

List professional activities & organizations to which you belong:

Briefly describe, in no more than 500 words, why you would like to participate in the Leadership Academy (You may choose to write your response on a separate sheet if you prefer.):

Briefly describe, in no more than 500 words, long-term career goals and why or how you plan to reach those career goals (You may choose to write your response on a separate sheet if you prefer.):

Leadership Academy Agreement

Council on Student Affairs

Please print and submit this signed document as instructed below.

As an applicant to participate in the Council on Student Affairs Leadership Academy, if accepted as a participant in the Academy, I understand and agree:

• That completion and submission of this application does not ensure my acceptance in the Academy;
  
• With the purpose and mission of the Academy stated on page four of the Guidebook and, if selected, will devote the time necessary to complete the Academy as required;
  
• That I am expected to attend all forums offered by the Academy*;
  
• That my sponsoring institution understands that, from time to time, I will be away from my work assignment in connection with my participation in the Academy;

• That I or my institution will pay the $125 Academy tuition fee; and
  
• That I will receive a certificate acknowledging that I fulfilled the minimum expectation for completion of the Academy by having participated in at least five programs during an academic year.*

*The Council understands that from time to time a work conflict will prevent one from attending one of the Academy’s programs. Therefore, the Council will make Academy members aware of other professional development opportunities that may be used in place of one and only one of the five programs in which Academy members are required to participate in order to receive the certificate of completion. HOWEVER, the first session is absolutely required of all participants as it provides an introduction and overview of the entire Academy experience.

Applicant’s signature ______Date ______

Supervisor’s signature ______Date ______

Chief Student Affairs Officer signature ______Date ______

Agreement form must be submitted to:

By email to:

Or by fax to: (405) 225-9392, Attn: Holli Hurst

Or by mail to: Oklahoma State Regents for Higher Education

Attn: Holli Hurst (or Kermit R. McMurry)

PO Box 108850

Oklahoma City, OK 73101-8850