PARTICIPANT APPLICATION FORM: CLASS OF 2016
LEADERSHIP NETWORKS 201
Preamble:
Leadership Networks is an amazing opportunity to develop your leadership potential. It is rare that
you find a program that gives you practical skill development and the time to practice and integrate the
new learning, all within a supportive group environment. The curriculum is specifically designed and
delivered for adult learners who are committed to developing their leadership skills.
As of June 2015, there will be 247 graduates from the Leadership Networks programs. As you look
around your communities, Networks’ Alumni are contributing to the health and growth of the region.
We encourage applications from the public, private and not for profit sectors of Central Alberta. It is
our goal to have a diverse group of current and emerging leaders. We welcome applications and
inquiries from anyone who is interested in becoming part of a network of informed community leaders.
Selection Criteria: Candidates for the program should display the following qualities:
a. A personal desire to take part in the program
b. A basic appreciation and understanding of leadership
c. Basic leadership abilities/qualities
d. An ability to contribute, at a meaningful level, to the program (through life experiences,
knowledge, skill, etc.)
e. Receptive and open to new ideas and opinions of others
f. An awareness of issues facing the community
g. Ability to contribute toward program evaluation
h. Commitment to contribute as an alumni member
This fall, the Leadership Networks program will be offering its 201 level course:
Leadership 201
This course is designed for those who are already in supervisory, team lead, management roles who
would like to focus on enhancing their skills in leading others
Course Themes:
 Enhance your Personal Leadership Style & Learn to Engage Other Styles
 Coaching Skills
 Negotiation Skills: getting to win/win
 Planning for Success: proactive personal goal setting and accountability
 Communication Skills: dealing with difficult people and having ‘tough’ conversations
 Facilitation Skills: engaging individuals, teams and your organization
 Unpacking the Problem: identifying the real issue
 Creativity: leading others through exercises to challenge their thinking & to discover new ideas
 Strategic Planning: discover a variety of planning techniques
Leadership Networks 201 ~ 2016 Application
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Leadership Networks 201 Course consist of 10 Learning Days:
 Two day Opening Retreat
 Six Learning Days ~ 8:30am – 5:00pm (full day commitment)
 Two day Closing Retreat
Application Deadline:
To receive fullest consideration applications should be submitted no later than 4:00 pm on
Sept 28th, 2015.
For further information call (403) 340-0324 or send an email to office@theleadershipcentre.ca.
Course Fees:
The participation fee of $3095.00 is due upon application to the program. Refunds will not be granted
after October 26th, 2015.
In order to increase personal commitment to the program, we encourage participants to pay a
minimum of 10% of the course fee from personal funds ($310.00).
Tuition Assistance:
Non-profit and small businesses may apply for tuition assistance. Consideration for tuition assistance
is based upon demonstrated need. To be considered for assistance you must ensure that your
employer completes the appropriate section on the Financial Commitment/Request for Tuition
Assistance page of this application.
(Participants that receive assistance and who are subsequently asked to withdraw from the program
will be required to repay the funds in full.)
Leadership Networks 201 ~ 2016 Application
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Financial Commitment/Request for Tuition Assistance:
All applicants are required to complete this form.
As indicated in the application package, each participant is encouraged to contribute a minimum of $310
from personal funds toward the tuition cost. Leadership Networks strives to provide tuition assistance to
those candidates who are accepted into the program and who demonstrate financial limitations that will
prevent participation.
Tuition assistance is determined based upon demonstrated need. Award amounts are restricted by the
number of requests and the amount of funds available on a yearly basis. To be considered for assistance
you must ensure that your employer completes the appropriate section below.
Please note: Participants that receive tuition assistance and who are subsequently asked to
withdraw from the program will be required to repay the funds.
Applicant’s Name: _____________________________________
Phone: _________________
Employer ____________________________________________
Phone: _________________
Amount you are contributing towards tuition:
$_______________ (minimum of $310)
Amount your employer is contributing towards tuition:
$_______________
Amount of assistance requested:
$_______________
TOTAL
$3095.0
Provide a brief statement of your financial need for tuition assistance, including a description of your
specific financial situation (use reverse side of application if more space is needed)
To be completed by ALL employers:
I confirm that our organization will contribute $___________ toward the above applicant’s tuition.
We feel that our applicant would be a good fit for:

Leadership Networks 201
________________________________________________________________________________
Signature
Date
________________________________________________________________________________
Print Name
Title
Leadership Networks 201 ~ 2016 Application
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Participant Commitment Form:
I understand the goals and commitments of LEADERSHIP NETWORKS. Full payment of the tuition
will be paid no later than Dec 15th, 2015 unless alternate arrangements have been made.
______________________________
Applicant’s Name
____________________________ ________________
Signature
Date
********************************************************************************************************************
I, as the applicant’s employer or supervisor, understand and agree to the time commitment.* The time
commitment for Leadership Networks includes:
Leadership 201
September 28, 2015
November 11 & 12, 2015
December 3, 2015
January 7, 2016
February 4, 2016
March 3, 2016
April 7, 2016
May 5, 2016
June 9 & 10, 2016
June 10, 2016
Application Deadline
Opening Retreat
Learning Day 1
Learning Day 2
Learning Day 3
Learning Day 4
Learning Day 5
Learning Day6
Closing Retreat
Graduation (evening 2-3 hours)
Please note, occasionally special events are scheduled at the conclusion of learning days such as
‘meet and greet’ with local leaders or tours of facilities. It is expected that participants attend these
events as part of the learning day.
In addition, each participant will be required to schedule time for informal learning experiences
including:
- Pre-reading associated with the Opening Retreat, Program Days and Closing Retreat
- Identified reading for the course
- Community Project Team meetings
- Individual Projects
Participants should expect to commit approximately 20 hours per month to the program.
________________________________
Supervisor’s Name
___________________________
Signature
________________
Date
Phone Number: ________________________
Not applicable if working in a partnership or self employed*
Leadership Networks 201 ~ 2016 Application
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Section 1:
Personal Information:
Name of Applicant: __________________________________________________________
Home Address: _______________________________ Home phone:__________________
Mailing Address: ____________________________________________________________
E-mail Address: __________________________________Cell: ______________________
Date of Birth: _____________________________ Gender: __________________________
Work Information (if applicable):
Current Position: ____________________________________________________________
(Please note if you are unemployed, retired, or working from home)
Workplace Address: _________________________________________________________
Workplace Phone: _______________________________ Cell: _______________________
E-mail Address: ____________________________________________________________
Present Employer/ Agency: ___________________________________________________
Supervisor’s Information (if applicable):
Supervisor’s Name: __________________________________________________________
Supervisor’s Workplace Phone: ________________________________________________
Supervisor’s E-mail: __________________________________________________________
Please provide a current resume including employment history, volunteer experience,
educational background, awards etc. and any other training completed.
Which of the three sectors do you feel you best represent:

Non-Profit Sector

Public Sector (government employees)

Private Sector

Other (retired, volunteer, etc.)
Leadership Networks 201 ~ 2016 Application
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Section 2:
1. What are your personal leadership goals and how will this program help you reach
them? What is your motivation for being a part of this program?
2. How do you anticipate investing the skills and experience you develop in Leadership
Networks?
Section 3:
Short Answer – topics (please limit your answers to ½ type written page per question).
Please answer both questions
i. What unique qualities or experiences will you bring to the Leadership Networks program?
ii. In your opinion, what is the most pressing issue or challenge facing the Central Alberta
region and why? How would you be involved in its solution?
Leadership Networks 201 ~ 2016 Application
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Section 4a:
Name of Nominator or Reference: _______________________________________________
Workplace Phone: ____________________________________________________________
Briefly describe how long you have known the applicant and the nature of your relationship:
Based on your knowledge of the applicant, provide examples of how they have demonstrated
leadership qualities in their professional and/ or community involvement.
Describe why you believe this person is an excellent applicant for Leadership Networks.
Signature: __________________________________________
Leadership Networks 201 ~ 2016 Application
Date: __________________
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Section 4b:
Name of Nominator or Reference: _______________________________________________
Workplace Phone: ____________________________________________________________
Briefly describe how long you have known the applicant and the nature of your relationship:
Based on your knowledge of the applicant, provide examples of how they have demonstrated
leadership qualities in their professional and/ or community involvement.
Describe why you believe this person is an excellent applicant for Leadership Networks.
Signature: ___________________________________________
Leadership Networks 201 ~ 2016 Application
Date: _________________
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