Participant Application Form

Location *

The Corvallis class is full. Space is still available in the Newport class.

I will attend sessions at the Hatfield Marine Science Center in Newport

I will attend sessions in Corvallis - CLOSED

Your Commitment

I commit to: *

Attendance for the duration of all 6 sessions.

Action Plans - design and complete Action Plans to practice skills on-the-job.

On-the-Job Practice – implement Action Plans and practice 2-4 hours per week.

Teamwork - share experiences and expertise, listen to and learn from colleagues, contribute to Learning Teams.

Collaborative Learning Community – support the success of colleagues.

Meet with supervisor on a consistent basis to review Action Plans and get support to develop and utilize Leadership skills on-the-job; and

Provide feedback and ideas for program improvement and development.

Approval *

I have discussed the program with my supervisor, including all participation and time requirements.

My supervisor has given approval and release time for 2-4 hours per week to practice Leadership skills on-the-job for the duration of fall2017 LCI.

You and Your Position @ OSU

First/Last Name (As you would like for it to appear on a name tag and roster): *

Department: *

Email: *

Phone Number

ONID Username: *

Primary Employee Classification: *

Classified

Professional Faculty

Academic Faculty

Are you in a management position *

Yes

Supervisor: *

Essay Questions

1. Describe how developing and using Leadership skills will contribute to the quality and effectiveness of your work. *

2. Participation in the LC requires that participants spend 2-4 hours per week to practice Leadership skills on-the-job. Describe how your workload accommodates this additional work for the duration of the fall2017 LCI. *

3. The LCI utilizes Learning Teams to support individual learning. The success of Learning Teams requires that its members practice new Leadership skills on-the-job 2-4 hours per week. Describe the contributions you can make to your Learning Team by practicing new Leadership skills on-the-job 2-4 hours per week. *

Learning Collaborative II and Beyond

Acknowledgement *

I understand that to be considered for subsequent Leadership Collaborative programs, I need to successfully complete Leadership Collaborative I: Emergence. Successful completion is defined by fulfillment of commitments listed above.

Once participant selections have been made, a separate form will be provided to formalize this agreement. Supervisor signature will be requested, but may not be applicable, depending on your position.

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Leadership Collaborative I: Emergence

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