C-Change 2025, Class 20, Application

Your Organization Information
Company/Organization*
Job Title*
Company Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is the nature of the business/organization? *
Do you have full support from your employer for the tuition financial commitment required to take participate in the program? Financial commitment from organization is not required. There is an option for self-pay or a combination of self and organization pay.

YesNo
Do you have full support from your employer for the required time away from work to participate in the program?

YesNo
Your Supervisor's name:
Your Supervisor's Email:
Do you lead people or a team, either directly or indirectly? Describe briefly.*

0/1500

Your Employment History

Begin with your current employer and go back successively through your previous 1-2 employers. Include years of work.
Current Employer
Previous Employer #1
Previous Employer #2
Previous Employer #3
Previous Employer #4
Please type your biographical sketch below. Bios should be limited to 100 words. A sample sketch is noted below the box. This information, along with your headshot, will be published in a directory to all participants.*

e.g. "Mary Ann Moore, researcher and writer, president of the Smith Associates consulting firm. She received her B.A. in Political Science from the University of Chicago. In recognition of her work as Director of Public Information for the City of Cincinnati, she was chosen one of Cincinnati's Women of the Year in 2005. A former staff member of the United Way, she is a board member of the Mental Health Association, WCET, and Council on World Affairs. In addition to family activities with her husband, Geoff and their son, she enjoys photography, travel, and tennis."0/0100

Grant Request
Grants: Partial grants up to $1,300 may be available for small non-profits, entrepreneurs, or those self-paying base on need. Would you like to apply for grant money?

YesNo
If yes to applying to grant, enter grant amount requested:
If yes to applying to grant, please briefly explain why you are requesting financial assistance and how you think your participation in the program would provide a distinct and positive addition to the class.
If you do not receive the grant requested, will you still be able to take part in the program if accepted?

YesNo

Long Answer Questions

Please bring your true self to the application. So often individuals are trying to be so professional that we do not get to know them. We want to get to know you.
Why do you want to take part in C-Change? i.e. What are some goals you would like to achieve through your participation, both during the program year as well as beyond?*
How might you apply insights from the program to work and/or your community?*
Share your Relevant Leadership Experience & Community Involvement. Please list membership, leadership roles and/or awards in school, community, civic, professional, religious and social organizations that have been of significance to you. Include years/dates. Note that having relevant leadership experience and community involvement is not a requirement of the program. Not limited to experiences that would go on a resume. Soccer coach, etc., count! Max of 1000 words. Include years.*

0/1000
Briefly describe a significant accomplishment (can be professional, personal, community, etc.). Please list membership, leadership roles and/or awards in school, community, civic, professional, religious and social organizations that have been of significance to you. Include years/dates. Note that having relevant leadership experience and community involvement is not a requirement of the program.*

0/1500
Briefly, from your perspective, what is our region's greatest challenge?*
Describe a mistake from the last five years that had a big impact on your personal or professional life, and how that experience changed the way you operate/what you learned.*

0/1500
What will you bring to the C-Change class? The program is very competitive. Why should you be selected? *

0/1500
Describe one of the most impactful experiences you have had in the Cincinnati region.*

0/1500
Please share with us something else, not mentioned in this application, that will help us get to know you better as an individual. This can be personal or professional, serious, or fun.*

0/1500
How do you respond when being challenges regarding something that is prohibiting progress? Share a specific example.*

0/1500
What are your (up to 3) professional goals and what do you need to do to reach them?*

0/1500

Participants of the program may be asked to engage in pre-class assignments that will require approximately 1-2 hours during the weeks prior to each session. Will you be able to contribute the time needed to fulfill these assignments?

YesNo
Participants of the program will be required to take part in a small group project that will require approximately 4-6 hours/month outside of the sessions. Will you be able to contribute the time needed to fulfill this requirement?

YesNo
I understand the purpose of C-Change, the attendance requirements, and the time and energy necessary to make it a successful experience. I will commit fully to the program and will block my calendar on the following dates to make this a priority.

YesNo
Please upload your preferred headshot.*

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Signature*

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Your Basic Information

Your Organization Information

Your Employment History

Grant Request

Supplemental Information

Long Answer Questions