Inclusive Leadership Alumni Application 2023-2024 Inclusive Leadership Alumni Application for the 2023-24 Academic Year Date MM slash DD slash YYYY Name First Last TitleAlumni Type EWU Undergrad Alumni EWU Graduate Alumni EWU Certificate Program Alumni Select AllEmployerCampus AddressEmail Work PhoneCell Phone or Home PhoneHighest level of education High School Some College Business/Trade School 4-Year Degree Masters Doctorate Other Title of person to whom you report:Number of individuals who report to you:Years at Current Employer (if applicable)Please provide a brief description of your current responsibilties (if applicable):Describe key past and present accomplishments. Please be as specific as possible:Please explain your objectives and goals as they relate to attending this program:Please describe what you think other program participants may learn from you (e.g. perspectives, skills, expertise):Please explain what you believe to be the most formidable challenges facing your organization and/or business unit:Please list or describe some topics/discussions that you hope to cover in this program:Name of Supervisor or Professional Reference:Supervisor or Professional References Email:Please note that the Inclusive Leadership Program is a competitive process. For the fairness of other applicants, please do not apply if you are unable to make the following commitments to the program. Payment Policy: Typically, this program requires a $50 nonrefundable fee and the participants purchase their own monthly curriculum. However, due to the grant from U.S. Bank, the fee and materials are covered for those participating in the program in 2024. I have read the payment policy and agree to the terms stated. (Please initial here) Attendance Policy: Expectations include attending all of the 5 sessions in person (or available via Zoom). If you are unable to attend a session, please email Kim Davis at kdavis2@ewu.edu. Of course, we understand that emergencies arise; however, the goal of this program is to learn and grow from each other with full participation. Thus, a commitment to attendance from all parties is necessary. Participants who are absent from one or more sessions may be asked to leave the program.The meeting will take place on the 3rd or 4th Tuesday of each month on the following dates, in person or via Zoom:Tuesday, January 23, 2024, 5:15pmTuesday, February 20, 2024, 5:15pmTuesday, March 19, 2024, 5:15pm Tuesday, April 23, 2024, 5:15pmTuesday, May 21, 2024, 5:15pmI have read the attendance policy and agree to the terms stated. (please initial here)I acknowledge and agree this training opportunity is being provided for personal professional development and is not considered part of my job assignment. Participation is voluntary and not required by the University, so attendance will not be considered work time. As this is not a work sponsored training, the University is not responsible to pay any fees or expenses associated with the program. I certify that all the information and accompanying material provided in connection with this aplication are authentic and accurate. Signature I awknowledge and agree with the statement above. Δ