The City of Columbus Department of Neighborhoods New American Leadership Academy Application 2023

Section 1: Personal Information

First Name*

Last Name*

Gender

Male

Female

National Origin*

Date of Birth (MM/DD/YYYY)*

Email*

Cell Phone Number*

Phone

Work Phone Number

Phone

Section 2: Mailing Address

Street Address*

Address Line 2

City, State*

Postal/Zip Code*

Section 3: Education

Are you currently a student?*

Yes

No

If yes, where:

What is the highest level of education you have completed?

High School

Some College

Trade/Technical/Vocational Training

Associate's Degree

Bachelor's Degree

Master's Degree

Professional Degree

Doctorate Degree

Highest Degree Obtained*

Section 4: Employment

Are you currently employed?*

Yes

No

Employer Name

Title

Supervisor's Name

Supervisor's Phone Number

Supervisor's Email

Section 5: Work Address

Street Address

Address Line 2

City, State

Postal/Zip Code

Section 6: Background

Have you previously applied for the New American Leadership Academy?*

Yes

No

Have you previously taken any leadership development courses?*

Yes

No

If yes, please list below

If applicable, please list current and previous community involvement.*

This course requires a multi-month commitment. Sessions will be held on weekday evenings from 5:00 p.m. to 7:30 p.m. Can you commit to this time table?*

Yes

No

Section 7: Free Response Questions

The free response section of the NALA application will be used to learn more about who you are, and what you are looking for in NALA. Provide detailed responses to the questions below. Please limit your responses to 500 words.

What would you like to learn from the New American Leadership Academy?*

How do you plan to use your New American Leadership Academy experience?*

What unique qualities do you bring to the New American Leadership Academy?*

Please provide any additional information about yourself that you believe would be relevant to the selection committee.*

How did you hear about the New American Leadership Academy?*

Please provide your most up to date resume/CV and headshot*

Resume/CV must be in PDF or Word format and OPTIONAL Headshot must be in JPEG or PNG format

Drag and drop files here or

Section 8: Applicant Commitment

Upon acceptance to the New American Leadership Academy, I am expected to respect and honor the opinions and beliefs of others. I am expected to remain professional and mindful of the overall goals and objectives of the program. I am also aware that the program will not tolerate any behaviors such as overt alienation of participants/individuals because of their beliefs, inappropriate forms of communication, and a display of strong emotions, that would interfere with the integrity, mission and objectives of the program. I understand the time commitment and the program goals. If selected, I plan to attend each session in its entirety. I understand that if I miss more than two sessions or fail to actively participate, I may not complete the program and may be ineligible for future participation. I further agree that the information presented herein is accurate and complete to the best of my ability and that no omissions or false statements have been made to justify my participation in the program.

I have read the previous statement and agree to the applicant commitment.*

Yes

No

I have reviewed and confirmed the accuracy of all information provided in this application.*

Yes

No

Electronic Signature:*

Send me a copy of my responses