I am applying for Leadership I Series *

How many times have you previously applied? *

GRPA District *

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Name *

Gender *

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Email *

Phone *

T-Shirt Size *

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XL

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Home Address *

Present Employer *

Business Address *

Present Title or Position *

Brief Description of Job Responsibilities *

Direct Supervisors Name *

Contact Number *

GRPA or Professional Affiliations and Service Organization Activities *

Name of Group *	Position Held or Assignment *	Period of Affiliations *
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Employment History *

List present position first

Employer *	Title *	Period of Service *
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List community activities that you have or are currently participating in: *

List in order of importance

List special awards, offices, and/or recognitions *

Educational Background *

School *	Diploma/Degree *	Years Attended *
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Define what "Leadership" means to you: *

What are your career goals? *

What leadership qualities do you possess? *

Are there any leaders that inspire you? *

Have you ever taken on a leadership role voluntarily? If so, please explain. *

How do you advocate recreation & parks within your community? *

What leadership roles or committees do you want to be involved with or are already involved in? *

Check Box: *

If selected, I agree to serve and help with the Silent Auction Committee leading up to and during the GRPA Annual Conference this year. 

Check Box: *

If selected, I agree to assist in working the GRPA Annual Conference as a Room Moderator, at the Registration Desk, or in the Speaker Hospitality Room.

Check Box: *

If selected, I agree to consider participation in a state committee, leading a committee, or serving on a Network or District Executive Committee. 

Agency Director Acknowledgement *

My director fully supports me to attend the George Harris Leadership Series applied for, and will allow me to attend, if selected. Additionally, upon completion of the program, they will encourage me to volunteer and become involved with GRPA on the District and State Levels.