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LEADERSHIP ACADEMY PLEASE COMPLETE THIS FORM WITH ALL (Mohawk Valley Community College)

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LEADERSHIP ACADEMY
CENTER FOR LEADERSHIP EXCELLENCE | 1101 SHERMAN DRIVE | UTICA NY 13501
315.792.5321 | clemv.org | cle@mvcc.edu
PLEASE COMPLETE THIS FORM WITH ALL INFORMATION REQUESTED FOR EACH SECTION.
Name (first, middle, last):
Company/Organization:
Job Title:
Home Address:
Home City:
State:
Zip:
Home Telephone:
Home E-Mail Address:
Cellular Telephone:
Work Address:
Work City:
State:
Zip:
Work Telephone:
Work E-Mail Address:
Work Fax:
For written communication, would you prefer that we use your home or work mailing address? Home Work
For electronic communication, would you prefer that we use your home or work email address? Home Work
PLEASE INCLUDE A CURRENT RESUME WITH THE SUBMISSION OF YOUR APPLICATION.
OTHER CONSIDERATIONS
Why is Leadership Academy the right program for you? What skills or knowledge do you hope to gain?
LEADERSHIP ACADEMY
CENTER FOR LEADERSHIP EXCELLENCE | 1101 SHERMAN DRIVE | UTICA NY 13501
315.792.5321 | clemv.org | cle@mvcc.edu
EXPECTATIONS
Leadership Academy is a ten-session program comprised of half-day classes starting in October 2020 as well as a graduation
ceremony in June 2021.
Commitment to participating in Leadership Academy centers on involvement in all program days and graduation.
Attendance is strongly encouraged for the ten program day sessions and graduation. Missing more than the equivalent of
2 sessions (virtual or in-person) will jeopardize a participant’s eligibility for graduation.
TUITION
The Leadership Academy program tuition is $1,800, which covers all program related expenses during the 10-session
program term. Unfortunately, we do not offer program refunds after the class start date.
If selected, full tuition must be received within 30 days of notification and/or no later than S
e
ptember
30th.
APPLICANT AGREEMENT
I have read and understand the commitments required of the Leadership Academy program. I am willing to attend all
required sessions/functions of the Center for Leadership Excellence/Leadership Academy and devote the time necessary
to be a contributing member of the class. I understand that if I fail to meet these obligations I will not be permitted to
graduate from the program and will not receive a refund of my tuition.
I am responsible for the $1,800 tuition fee.
My employer/sponsor is responsible for tuition
(obtain signature below)
Applicant Signature Date
EMPLOYER AGREEMENT
Applicants for Leadership Academy must have the support and commitment of their employer. The signature of the
employer are required as an indication of complete support of the applicant’s participation. Financial support
indicates willingness to pay the applicant’s tuition. Release time support indicates willingness to provide
the applicant with time off from work to attend program days.
E
MPLOYER
W
ILL COMMIT TO
:
(check all that apply)
Release time support
Financial support
Employer Signature
Print Name/Title/Organization
Date
Email Address
Please check each box to ensure application includes:
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LEADERSHIP ACADEMY PLEASE COMPLETE THIS FORM WITH ALL (Mohawk Valley Community College)

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Completed 26 July 2020

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