I am applying for Leadership Beyond Series *

Date of completion of Leadership II? *

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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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 *

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

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List special awards, offices, and/or recognitions *

Educational Background *

School *	Diploma/Degree *	Years Attended *
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Tell me about a time you struggled with a work-life balance. *

Tell me about a time your idea improved your agency/community. *

How did you ensure your idea was implemented? 

Describe your understanding of diversity & inclusion and why it is important to a leadership role? *

How have you advanced your leadership skills after completing Leadership I & II? *

If a team member is under performing, what steps do you take to improve their performance? *

What do you think is important in creating a positive culture? *

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

Check Box: *

If selected, I agree to commit to co-teaching a session as the GRPA Annual Conference.

Check Box: *

If selected, I agree to assist 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.