LEADERSHIP ACADEMY APPLICATION - COHORT 3 - 2015/16
IT@UC, the university’s IT community, partners with students, faculty staff and the
community to provide innovative and efficient technology solutions that support the
academic and research priorities of the university.
The IT@UC Lead Team launched the Leadership Academy for IT@UC to support and
cultivate the future leaders of information technology at the university. To date, two
cohorts have successfully graduated from this program, developing their leadership
competencies and building lasting partnerships along the way.
Instructions:
To begin, save this document to your own computer using you last name as part of the
file name. When ready to complete it, click on the shaded areas to input information.
DATE
CONTACT INFORMATION
(Please provide this information, as you would want it presented in publications)
NAME
PRIMARY PHONE #
E-MAIL
AREA OF THE UNIVERSITY OR TEAM TO WHICH YOU BELONG
POSITION
BUSINESS ADDRESS
CITY
SUPERVISOR NAME
STATE
ZIP
SUPERVISOR PHONE #
1
SUPERVISOR EMAIL
How long have you been in your current position?
Years worked at the University?
How did you hear/learn about IT@UC Leadership Academy?
OPTIONAL: To help us achieve a diverse program, please provide the following information:
Preferred Pronoun (He, she, ze, etc.)
Race/Ethnicity
Country of Origin
EDUCATION: (Begin with college(s), business or trade school(s) and/or other specialized training.)
Name & Location of School or Training From – To
Degree/Certificate
EMPLOYMENT: (Begin with your present employer and go back through your last three employers.)
From – To
Name & Location of Employer
Position
Reason for Leaving
ORGANIZATIONS AND ACTIVITIES: (Please list volunteer service/participation in community, civic,
business, professional, religious and social organizations that have been of significance to you.)
Organization
From – To
Responsibilities or Position Held
Attach a separate page if necessary.
ACCOMPLISHMENTS: List three of your greatest accomplishments (can be from any of the above
categories or personal). Briefly describe the situation, actions taken, the results and your leadership role.
Situation
Actions
Results
Leadership Role
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CREATIVE SOLUTIONS: Answer each of the questions below in 150 words or less.
1.
Describe one of the greatest challenges you’ve faced in the workplace. Include how you handled it,
who you involved, what outcomes resulted and what you learned from the experience?
2.
Describe your biggest failure and what you learned from the experience.
LEADERSHIP QUALITIES:
3.
Identify a significant role model in your career and describe how that person impacted your life and
leadership style.
4.
Why should you be selected for IT@UC Leadership Academy? Please include what you can
contribute to the program and what you hope to get out of the experience.
5.
What else can you tell us that will help us get to know you better as an individual? (This could be
personal or professional, serious or fun.)
REFERENCES
For your primary reference, please list the person who is most knowledgeable about your leadership
performance and potential and have this person complete the separate confidential recommendation
form. No other recommendations are required. No more than two additional letters may be submitted.
Primary Reference (completed form required)
NAME
PHONE
COMPANY/ORGANIZATION
ADDRESS
CITY/STATE/ZIP
E-MAIL
Other References (completed form or statements not required):
NAME
PHONE
COMPANY/ORGANIZATION
ADDRESS
CITY/STATE/ZIP
E-MAIL
3
NAME
PHONE
COMPANY/ORGANIZATION
ADDRESS
CITY/STATE/ZIP
E-MAIL
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ATTENDANCE REQUIREMENTS
A participant is expected to attend all sessions. Those who miss more than two sessions will be denied
graduation and asked to withdraw from the program.
 IT@UC Leadership Academy Kickoff – September 15th, 2015 Tuesday 8:30-3pm
 October 20th, 2015 Tuesday - 8:30-3pm
 November 17th, 2015 Tuesday - 8:30-3pm
 December 15th, 2015 Tuesday - 8:30-3pm
 January 19th, 2016 Tuesday - 8:30-3pm
 February 16th, 2016 Tuesday - 8:30-3pm
 March 15th, 2016 Tuesday - 8:30-3pm
 April 19th, 2016 Tuesday - 8:30-3pm
 May 17th, 2016 Tuesday - 8:30-3pm
 IT@UC Leadership Academy Graduation – June 21st, 2016 Tuesday – 8:30-2pm
Will you be able to fulfill this commitment? Yes
No
Do you have full support of your employer for the required time away from work? Yes
No
NA
I understand the purposes of IT@UC Leadership Academy, have reviewed the attendance requirements
and agree to devote the time and energy necessary to make it a successful experience if I am selected to
be a participant
Candidate’s Signature
Date
APPLICATION PROCESS CHECKLIST
SUBMIT VIA EMAIL TO:
Tiffiany Wilson – UCIT ESS wilsontf@uc.edu
cc – Diana Noelcke – UCIT ESS AVP noelckd@uc.edu
University Hall
51 Goodman Dr. ML0658
Cincinnati, OH 45221
APPLICATION DEADLINE: August 14th, 2015.
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