Application Submission Form - Claremont Graduate University

Getty Leadership Institute

Claremont Graduate University

160 East 10 th Street, Claremont, CA 91711

909.607.9477 gli@cgu.edu www.cgu.edu/gli

APPLICATION FORM

INSTRUCTIONS: You will need Adobe Reader software version 8 or above in order to complete and submit this form. Download a free copy from http://get.adobe.com/reader/.

Once you have completed this form electronically, click the “Submit by Email” button at the end of the form. This will send the form to GLI via your email account.

NEXTGEN 2016

Executive Education for the Next Generation of Museum Leaders

March 7-12, 2016 | Online

March 28–April 2, 2016 | Claremont Graduate University, California

Applicant Information (complete all fields)

Name to be used on all official GLI printed materials

First Name Middle Name Last/Family Name Suffix

Institution

Business Mailing Address (please provide a street address, not a P.O. box)

Professional Title

State /Province Country City

Phone Number Email

Website Address

All application materials due by

January 4, 2016

Preferred Name for Nametag

ZIP/Postal Code

Position Information

Number of years in museum field?

Number of years at this institution?

Number of years in current role?

Select your primary area of current responsibility:

Administration/Operations

Conservation

Curatorial

Development/Institutional Advancement

Education

Exhibitions

Finance

Human Resources

Information Technology Systems

Public Programming

Public Relations/Marketing

Registrar/Collections Management

Other responsibility, specify below:

© 2016 GLI@CGU

Institutional Information

Select the museum type that most closely corresponds to your institution:

Art Museum

Botanical Garden

Children’s Museum

History Museum

Mixed-Discipline Museum

Natural History Museum

Science Museum or Center

Cultural Museum

Service Organization

Other, please specify:

Your museum’s annual operating budget (U.S. $)

Number of full-time staff employed by your museum

Your museum’s annual attendance

Your department’s annual operating budget (U.S. $)

Number of full-time staff in your department

Number of full-time staff whom you supervise

Institutional funding (complete both fields):

Private % + Public % = 100%

Please select all that apply:

Nested in Government

Nested in a University

Free-standing

Personal Information (For Statistical Purposes Only)

Gender: Male Female

Date of Birth:

Citizenship:

U.S. Citizen

Other Country

U.S. Permanent Resident:

Yes No N/A

Ethnicity:

Page 1 of 9





NEXTGEN 2016




Brief Statements and Analysis

First Name

1.

Middle Name Last/Family Name

Describe an opportunity for innovation in your department or institution. Explain any challenges you face in implementing change in this area. Discuss some actions you have already taken. (200-400 words)

© 2016 GLI@CGU Page 2 of 9





NEXTGEN 2016




Brief Statements and Analysis (continued)

First Name

2.


What motivates you to participate in NextGen 2016? What are your expectations for the program? (200 words)

3.

Describe what your participation would contribute to the NextGen 2016 expericence for others in the program. (200 words)






NEXTGEN 2016





First Name

4.


Watch the TED talk, What is takes to be a great leader ( http://bit.ly/1q6Sssd ) by Rosalinde Torres. Choose 1 of the 3 critical questions she poses. Discuss the relevance of that question to your own museum leadership and specific ways it relates to your institution or department. (200-400 words)






NEXTGEN 2016





First Name

5.


THINK PIECE: Museum are currently facing issues around innovation, sustainability, measuring success, and global connectivity—among others. Consider the issues in the museum field that concern you. Write a story about your role in the year 2025 as a museum leader addressing one or more of the issues most important to you. (200-400 words)






Financial Information (complete all fields)

First Name Middle Name

Please complete the information below as requested.

1. Total program fee

NEXTGEN 2016




Last/Family Name

$ 3,000

2. Estimated travel expenses

3. Amount of program fee paid by your institution

4. Amount of travel expenses paid by your institution

5. Your annual salary (required information) $

6. Personal contribution (skip to line 7 if your institution is paying the full program fee + travel expenses) $

7. Grants*

*Many government agencies and private foundations provide grants that may assist participants.

If you raised funds from outside sources to cover your program fee and travel, enter it here.

8. Total contribution to program fee (add lines 3, 6, and 7)

9. Subtract line 8 from line 1**

$

**If there is a positive balance on this line, complete the Statement of Need on the next page.

$

$

$

$ 0

$






NEXTGEN 2016




Statement of Need (if necessary)

First Name Middle Name

0

Last/Family Name

Because some institutions and individuals may not be able to bear the entire financial cost of attending the program, GLI will consider needbased requests for a reduced program fee for eligible participants. Travel will not be subsidized by GLI.

If there is a positive balance on line 9 in the Financial Information section above, you may request a reduced program fee.

I wish to request my program fee be reduced to $

In the space below, explain the unique circumstances that limit your personal and/or your institution's ability to contribute to the cost of the NextGen 2016 Program. Elaborate on efforts you have made to garner financial support from outside sources.






NEXTGEN 2016




Letters of Recommendation (complete all fields)

First Name Middle Name Last/Family Name

Letters of recommendation should be sent directly from your recommenders to apply.gli@cgu.edu

by January 4, 2016 with your last name in the subject of the email. Please provide the names and emails of the individuals providing letters in support of your application:

Recommender #1 (REQUIRED), a leading executive within your institution with firsthand knowledge of your work and abilities (board chairman, president,

CEO, dean, director, your division or department head, etc.):

Name Email

Recommender #2 (REQUIRED), a senior-level professional colleague outside your institution with firsthand knowledge of your contributions to the museum field):

Name Email

REVIEW THE APPLICATION SUBMISSION GUIDELINES FOR NEXT STEPS

Note: Submissions that are missing any of the items detailed in the Submission Guidelines will not be considered.

I agree that, to the best of my knowledge, the information I have provided in this application is true and accurate. I grant permission to GLI to verify any and all parts of my application.

Today's date:

MM/DD/YYYY

Short Survey - Advertising

(for statistical purposes only)

1. What sources of information about the Getty Leadership Institute influenced you to make a submission to this program?

GLI Alumni GLI at CGU Website

Colleagues (other than GLI Alumni)

GLI direct email

Forwarded email

Social media

GLI at CGU Staff

Advertisements

CAA News e-newsletter

AAM Dispatches e-newsletter

ArtsJounal e-newsletter

Other:

Field publications

Professional list-serve






NEXTGEN 2016




Short Survey - Leadership

(For statistical purposes only - not considered in the competitive application process. This data will form a base line for your personal learning objectives. Please consider each question carefully and answer thoughtfully.)

Please rate the following on a scale of 1-5:

1 2 3 4 5

(strongly agree) (agree) (neither agree nor disagree) (disagree) (strongly disagree)

I self-identify as a leader.

I understand and can communicate the mission and vision of my organization.

I identify opportunities to improve systems and processes in my work.

I identify opportunities to improve systems and processes in department/organization .

I am aware of my strengths and weakenesses as a museum leader.

I have a strong personal leadership development plan.

I am effective in building alliances for my organization/department that garner resources.

I understand of how to relate to my staff and effectively to motivate teams.

I use strategy to develop an idea from concept to implementation.

My life is well balanced between personal and professional needs.

Submit by Email


Application Submission Form - Claremont Graduate University

APPLICATION FORM

Applicant Information (complete all fields)

Brief Statements and Analysis

Brief Statements and Analysis (continued)

Brief Statements and Analysis (continued)

Brief Statements and Analysis (continued)

Financial Information (complete all fields)

Statement of Need (if necessary)

Letters of Recommendation (complete all fields)

Short Survey - Advertising

Short Survey - Leadership

Submit by Email

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Application Submission Form - Claremont Graduate University

APPLICATION FORM

Applicant Information (complete all fields)

Brief Statements and Analysis

Brief Statements and Analysis (continued)

Brief Statements and Analysis (continued)

Brief Statements and Analysis (continued)

Financial Information (complete all fields)

Statement of Need (if necessary)

Letters of Recommendation (complete all fields)

Short Survey - Advertising

Short Survey - Leadership

Submit by Email

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