LEADERSHIP MOHAWK VALLEY
CENTER FOR LEADERSHIP EXCELLENCE | 1101 SHERMAN DRIVE | UTICA NY 13501
315.792.5321 | clemv.org | cle@mvcc.edu
LEADERSHIP MOHAWK VALLEY SEEKS INDIVIDUALS WHO:
Represent a cross section of our community including business, education, government, arts, clergy, service and
community organizations, with various ethnic backgrounds, ages and gender;
Have demonstrated potential for leadership in the community and a sincere commitment and interest to serve the
Mohawk Valley community;
Demonstrate a genuine interest in being involved in shaping the future of the Mohawk Valley and developing their role
in influencing important issues facing our community;
Have the availability of time to complete the Leadership Mohawk Valley program with the full support of the
organization he/she represents; and
Upon completion of the program, desire to seek roles on community boards, commissions, key volunteer leadership
roles or public office, and participate in Leadership Mohawk Valley alumni activities and opportunities.
PLEASE COMPLETE THIS FORM WITH ALL INFORMATION REQUESTED FOR EACH SECTION.
PERSONAL DATA:
# of Years in the
Mohawk Valley:
Name (first, middle, last):
Company/Organization:
Job Title:
Home Address:
Home City:
State:
Zip:
Home Telephone:
Home E-Mail Address:
Work Address:
Work City:
State:
Zip:
Work Telephone:
Work E-Mail Address:
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.
COMMUNITY ACTIVITIES
Please list, in order of importance to you, any civic, religious, community, athletic, social or other organizations/activities
of which you are, or have been a member or participant (i.e. Heart Run & Walk, Rotary, etc). Please note any leadership
positions held.
O
RGANIZATION
T
ITLE
/R
ESPONSIBILITY
M
EMBER
F
ROM
T
O
H
OURS
/M
ONTH
LEADERSHIP MOHAWK VALLEY
CENTER FOR LEADERSHIP EXCELLENCE | 1101 SHERMAN DRIVE | UTICA NY 13501
315.792.5321 | clemv.org | cle@mvcc.edu
OTHER CONSIDERATIONS
Why is Leadership Mohawk Valley the right program for you?
Please identify and discuss a particular opportunity or challenge you believe is associated with the Mohawk Valley:
What experiences, strengths and characteristics you will bring to the Leadership Mohawk Valley program?
Please share something about yourself that we would not learn from reading your resume and explain the impact this has
had on you as a leader:
LEADERSHIP MOHAWK VALLEY
CENTER FOR LEADERSHIP EXCELLENCE | 1101 SHERMAN DRIVE | UTICA NY 13501
315.792.5321 | clemv.org | cle@mvcc.edu
EXPECTATIONS
Leadership Mohawk Valley is a ten-session program comprised of an opening retreat in October 2020, monthly program
days, a closing retreat as well as a graduation ceremony in June 2021.
Commitment to participating in Leadership Mohawk Valley centers on involvement in all program days, opening retreat,
closing retreat and graduation. Attendance at the opening retreat and graduation is required and is strongly encouraged
for each program day session and closing retreat. Missing more than the equivalent of 2 sessions (virtual or in-person)
will jeopardize a participant’s eligibility for graduation. Unfortunately, we do not offer program refunds after the class
start date.
TUITION
The Leadership Mohawk Valley program tuition is $2,400, which covers all program costs, including opening retreat,
program days, closing retreat and graduation related expenses during the LMV program term.
If selected, full tuition must be received within 30 days of notification and/or no later than September
30
th
.
APPLICANT AGREEMENT
I have read and understand the commitments required of the Leadership Mohawk Valley program. If selected, I
am willing to attend all required sessions/functions of the Center for Leadership Excellence/Leadership Mohawk Valley
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 and will not receive a refund of my tuition.
I am responsible for the $2,400 tuition fee.
My employer/sponsor is responsible for tuition
(obtain signature below)
Applicant Signature Date
EMPLOYER &/OR SPONSORING ORGANIZATION AGREEMENT
Applicants for Leadership Mohawk Valley must have the support and commitment of their employer and
sponsoring organization (if different). The signatures of the employer and sponsoring organization (where
appropriate) 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 opening retreat, program days and graduation.
E
MPLOYER (IF APPLICABLE)
W
ILL COMMIT TO
:
(check all that apply)
Release time support
Financial support
Employer Signature
Print Name/Title/Organization
Date
Email Address
S
PONSORING
O
RGANIZATION (IF APPLICABLE)
W
ILL COMMIT TO
:
(check all that apply)
Release time support
Financial support
Financial Signature (self or other)
Print Name/Title/Organization
Date
Email Address
Please check each box to ensure application includes:
complete form all appropriate signatures updated resume
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