Civic Leadership Program Application

If you have any questions or if you perceive any barriers in your ability to participate in Civic Leadership Program (examples: transportation, child care, work schedule, etc.), please contact us clp@learntoearndayton.org

Full Name

First Name

Last Name

Name you like to go by

Phone Number

Please enter a valid phone number.

Home Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

EmailPlease use personal email, not work email

example@example.com

How did you hear about us?Check all that apply

Word of Mouth

Friend/Colleague

Social Media Ad

Facebook

Twitter

Instagram

Print Media

Online Publication- article, blog post, etc.

Newsletter

Civic Leadership Program Information Session

Presentation

Event

None of the Above

Other

Please view the full Program Calendar before continuing to the Classmate Committment Section

By submitting this application, I confirm that I will:Check each box to confirm your commitment (If you do not check any of the following statements, please provide information in the box below.)

Attend all sessions, field trips, and other CLP commitments. Please review the calendar closely (LINKED ABOVE).

I have the needed support from my employer, school, family, and/or community to have the flexibility to attend all sessions (including evenings and weekends).

Arrive on time to, and prepared for, all sessions, field trips, and other CLP commitments. This includes completing the assigned work outside of class time so to contribute during our time together.

Actively participate and respectfully engage with presenters and classmates.

Commit the additional hours necessary (5-10 hours a week) to fully engage with the program, such as the time needed to help complete the group project or actively participate in the fundraising effort.

Complete surveys and evaluations for School Board School to help provide feedback to our staff.

Understand that more than three absences during the program means I will need to withdraw from the program and complete it in a future year.

Put in the work needed to figure out how my unique background, skill set, and life experiences can most benefit students in our community, and help my classmates find their place, too.

Continue working with the CLP coalition after the eight-month learning program to put learning into action and improve education outcomes for children.

Approve use of my image/likeness as a participant in CLP for the organizations' newsletter, blog, updates, social media, etc.

If you did not check a box to any of the previous questions, please provide a brief explanation.

As you answer the questions in this application, please keep in mind that the purpose of Civic Leadership Program (CLP) is to help interested community members discover more about the inner workings of local government and civic organizations, with a focus on public school boards. CLP may be the right fit for you if you:

Have an interest to (or have recently/currently) run for school board,
Have an interest to (or have recently/currently) run for local/regional office, with a focus on educational outcomes,
Are considering how you can leverage your passion, interest, and experience to impact student success, or
Are interested in better understanding the avenues and opportunities for local leaders to impact educational outcomes.

I am applying to Civic Leadership Program because:

I am considering running for elected office (e.x, city commission, school board member, other public office.)

I am currently running for elected office (e.x, city commission, school board member, other public office.)

I am currently serving in elected office (e.x, city commission, school board member, other public office.)

I want to make an impact on the school system from a seat other than as a school board member/city commissioner.

I’m not sure yet! I am hoping Civic Leadership Program will help me decide if I should run for public office or if I should make my impact from another seat.

Have you run for public office before or are you currently running?

Yes

If you have run for office or are currently running, what office/year?

Are you employed or in school?

Yes, I'm working full-time

Yes, I'm working part-time

Yes, I am a student or recently graduated

Yes, I am working and currently going to school

No, I am not currently working outside the home or in school

No, I am retired

Where do you work?

What is your job title?

(Optional) If you feel like your job title isn’t the clearest description of what you do, feel free to include a one line description of your work here.

What school do you currently attend / recently graduated from?

What is your field of study?

What civic/community organizations, boards, or fellowship programs have you volunteered with or been a part of? List up to five, and if you have school or district involvements (e.g., PTA), be sure to include those.

Organization

Position

Length of involvement

Volunteer Role #1

Volunteer Role #2

Volunteer Role #3

Volunteer Role #4

Volunteer Role #5

Volunteer Role #1

Volunteer Role #2

Volunteer Role #3

Volunteer Role #4

Volunteer Role #5

Organization

Position

Length of involvement

Organization

Position

Length of involvement

Organization

Position

Length of involvement

Organization

Position

Length of involvement

Organization

Position

Length of involvement

If you want to see all of the essay questions in one place, or if you want to work on the questions offline and then paste them into this online form, you can make a copy of the application essay questions here.

What about your background or experience makes you a strong candidate for CLP? (250 words or less)

What do you hope to gain from participating in CLP? (250 words or less)

When considering your local school board and/or community leadership – what is something going right? What is something you want to improve? Why? (250 words or less)

What is the issue/topic, as it relates to student success that is most important to you. Why? (250 words or less)

What do you believe the barriers are to student achievement in Dayton? (250 words or less)

What is the role of either the school board or local government to address the disparity between the students who are doing well and those who are struggling? (250 words or less)

Leadership in local governments, school boards, and/or community organizations often requires consensus or compromise. Share an issue on which you've changed your mind and explain your experience. (250 words or less)

(Optional) Is there anything we didn't ask that you really want us to know? (400 words or less)

Name/Contact of References

Name

Phone Number (optional)

Reference #1

Reference #2

Reference #1

Reference #2

Name

Phone Number (optional)

Name

Phone Number (optional)

Copy and paste this link to the reference form to send the Reference Form to two (2) references and follow up with them to be sure the forms are submitted by Tuesday, June 17th, 2025 at 12:00pm.

I have sent the reference form to two individuals.Reference Form Link: https://forms.gle/CkzwiiQ59SaGUcRq6

YESNO

Age:

Under 25

25-39

40-54

55-70

Over 70

Gender Identity

Male

Female

Other

Select your sexual orientation (choose all that apply):

Asexual

Bisexual

Gay

Lesbian

Pansexual

Queer

Same-gender loving

Straight (heterosexual)

Prefer not to answer

Other

Select the option(s) that best describe your religious affiliation:

Agnostic

Atheist

Baha’i

Baptist

Buddhist

Catholic

Church of Christ

Episcopalian

Hindu

Jehovah’s Witness

Jewish

Lutheran

Methodist

Mormon

Muslim

Non-denominational Christian

Orthodox, such as Greek or Russian Orthodox

Pagan

Pentecostal

Presbyterian

Protestant

Reformed, Christian

Sikh

Unitarian

Spiritual but not religious

Nothing in particular

Prefer not to answer

Other

Choose as many options as best represent your racial/ethnic identity, or please use the description option.

Ahiska Turks

American Indian or Alaska Native

Black or African American

Central Asian

East Asian

East African

Latinx and/or Hispanic (Non-white)

Latinx and/or Hispanic (White)

Middle Eastern

Native Hawaiian or other Pacific Islander

North African

South Asian

Southeast Asian

West African

White

Ukrainian

A race/ethnicity not listed here

Prefer not to answer

Other

Were you raised in the City of Dayton area?

YESNO

Are you raising/have you raised a school-aged child in the Dayton Public Schools?

YESNO

If yes - Choose all that apply:

My school-age children currently attend a DPS school

My children graduated from a DPS school

Are you raising/have you raised a school-aged child in a district other than Dayton Public Schools?

YESNO

If yes - Choose all that apply:

My school-age children currently attend a different school

My children graduated from a different school/school system

Please name the school/school system here:

Do you have a disability as defined by the Americans with Disabilities Act?

YESNO

If yes, please indicate any specific accommodations you would request for your learning experience.

Civic Leadership Program Application