Application for Class XVII

Application for Class XVII

Read each section before filling out this application. Responses should be professional, thorough, and complete.
Applicant Personal Details:
Name
Nickname or preferred name
Mailing Address
Physical Address
Cell Phone
Work Phone
E-mail address
example@example.com
How long have you lived in the Verde Valley
Employer
Job Title
Supervisor's Name
Employer/Supervisor's Contact Information
VVL is one Friday per month for 10 months. Does this interfere with your work schedule?

YesNo
If yes, would you have support from your employer to attend VVL on these days?

YesNoN/A
Professional References:
Name
E mail Address
example@example.com
Phone
Brief Explanation of Your Relationship
Name
E mail Address
example@example.com
Phone
Brief Explanation of Your Relationship
Applicant Questions:
1. Describe the duties and responsibilities of your current role or job
2. In order of importance to you please list your community, civic, professional, religious and/or social organizational memberships/activity involvement.
3. Please describe any leadership roles you have held in the groups identified above.
4. (a) What do you hope to gain from being a part of Verde Valley Leadership?
5. (b) What are your expectations of the program?
6. How did you hear about the Verde Valley Leadership program? Did someone recommend you to VVL? If yes, please specify:
Demographics
Gender

MaleFemalePrefer no to say
What is your age?

18-25 years old25-35 years old35-45 years old45-55 years old55-65 years old65+Prefer not to say
Please specify your ethnicity.

CaucasianAfrican-AmericanLatino or HispanicAsianNative AmericanNative Hawaiian or Pacific IslanderTwo or MoreOther/UnknownPrefer not to say
"What is the highest degree or level of education you have completed?"

Some High SchoolHigh SchoolSome CollegeAssociate's DegreeBachelor's DegreeMaster's DegreePh.D. or higherTrade SchoolPrefer not to say
Where is your home located

CottonwoodClarkdaleJeromeCamp VerdeRimrockVOCCornvilleSedonaYavapai CountyOther
What is your experience with Leadership?

Looking to get into leadership (NEW)Beginner (0-3 years)Intermediate (3-8 years)Advanced (8+ years in leadership)
Have you taken leadership courses in the past?

YesNo
Applicant Essay Question:
Identify two significant challenges we face in the Verde Valley. Why do you think these are significant community issues and what do you see as possible solutions? (Responses should include accurate spelling and proper grammar.)
(1)
(2)
Upload Your One Page Bio Here

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Upload Your Resume Here

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Thank you for your interest in Verde Valley Leadership.

Recruitment Committee, 928-595-1608

vvlpresident@gmail.com
VERDE VALLEY LEADERSHIP

INSPIRING INDIVIDUALS TO ACTION
Verde Valley Leadership reserves the right to execute a background check and ask follow up questions.

Application for Class XVII

Demographics