Thank you for your interest in the Child and Family Leadership Exchange (CFLE). Please complete each section of this confidential application in full. Limit answers to the space provided. This application must be signed by the applicant and employer/sponsor and returned to Summit County Children Services,
264 South Arlington Street, Akron, Ohio 44306 by April 30. If you have questions regarding this application, please call (330) 379-2055.
Child and Family Leadership Exchange participants will be i dentified by the program’s Selection Committee based on leadership potential, community service, ability to comply with the time commitment required, and clarity in response to application questions.
An important selection factor is the applicant’s ability to utilize the leadership skills gained through the program on a long-term basis to benefit the community. Participants selected for CFLE will represent the diversity of the professionals serving Summit County children and families. Appointments to CFLE are limited; applicants not selected may reapply in subsequent years. Once selected, participants are required to attend an overnight retreat and monthly day-long sessions, in addition to completing monthly pre-class assignments. Participants who fail to fulfill attendance requirements must withdraw from the program.
Tuition is non-refundable. Applicants must have full, written support of the organization they represent.
Name
Preferred First Name or Nickname
Employer
Job Title/Responsibility
Professional Licenses/Titles (Ph.D., MSW, LISW, etc.)
Business Address
City State Zip Code
Business Phone Business Fax
E-mail Address Cell Phone
Home Address
City State Zip Code
Home Phone Length of Residence in the Akron Area
Marital Status Spouse’s Name
Number of Children Names and Ages
Where did you hear about CFLE?

Beginning with high school, please list all degrees/certifications you have received. Degrees in progress may also be listed.
Name of School Date of Graduation Major/Area of Study Degree
List your principal extracurricular activities, offices held and special honors/awards for leadership activities or academics received while in school.
Name of School Description of Award/Activity/Honor
Present Employer
Title or Responsibility
How long have you been in this position?
Briefly describe your employment responsibilities
Which of the following categories best describes your current position? Please circle one.
Social Worker Supervisor Administrator Medical Professional Attorney School Official
Other (please specify)

List previous employment in reverse chronological order (include active military duty).
Employer Title/Responsibility Dates From-To Reason for Leaving
List business/professional affiliations using the full name of the organizations.
Name of Organization Position Held Dates From-To
In order of importance to you, list your community, civic, religious, political, social, athletic or other activities.
Name of Organization Position Held Dates From-To
What do you consider to be your most important accomplishment in one of the above organizations?
Why?
How much time each month do you commit to volunteer work? ___________________________________
If you have not had the time or interest to become actively involved, what conditions have changed that now enable you to seek involvement in the community?

What particular strengths and experiences would you bring to the program?
What do you hope to gain from, and how do you expect to use, your CFLE experience?
Briefly identify one pressing problem related to human services facing Summit County today and discuss your approach to solving it.
Is there any additional information you believe would assist the CFLE Selection Committee in assessing your qualifications?
Name and Title Phone
Business/Organization
Street Address
City State Zip Code
E-mai l
Name and Title Phone
Business/Organization
Street Address
City State Zip Code
E-mail
Name and Title Phone
Business/Organization
Street Address
City State Zip Code
E-mail

Thank you for applying to participate in the upcoming Child & Family Leadership Exchange Program.
Tuition. If selected to participate in the Child & Family Leadership Exchange Program, you or your sponsoring organization agree to pay a $1,000 non-refundable tuition fee before the start of the program.
Tuition fees cover program costs, including room and board at the overnight retreat. A limited number of scholarships may be available depending on grant funding. If you would like to apply for a scholarship,
please attach a separate letter signed by your agency director. Tuition is due by August 1, 2012.
Attendance. To be eligible for graduation from the Child & Family Leadership Exchange program, participants must attend all CFLE class sessions and events during the class year. This includes
Orientation, the Community Leaders Reception, the two-day overnight orientation retreat in September; and all monthly class sessions, including traveling with the class by bus when a bus is used. A graduation ceremony and dinner will be held in May 2013. In addition, participants are required to complete additional, pre-class activities each month. Though emergencies do arise, class members missing more than two sessions, for whatever reason, will not be eligible for graduation unless they complete equivalent requirements as approved by the CFLE Advisory Committee.
Considering the anticipated support from your employer and family, if you are unable to make the required commitment at this time, please apply at a future date.
(recommended participant’s name) has my full support for the time commitment required to participate effectively in the Child& Family Leadership
Exchange Program during the upcoming year.
Signature of Director/Executive Date
Printed Name of Director Name of Sponsoring Organization
As a potential participant in Child & Family Leadership Exchange, I understand that attendance is required and I commit to attend monthly class sessions, various preclass activities and special CFLE events.
Signature of Applicant Date
Applications must be postmarked by April 30, 2012.
All applicants will be notified of acceptance status in June .
The program year begins with Orientation in July 2012.