Cornerstone Program Application

Name

First Middle Last

Preferred First Name

Employer

Job Title

Business Email

Personal Email

Business Phone/Direct

Home Phone

Cell Phone

Work Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Preferred Address

Work

Home

Birthdate

Gender

Ethnicity

Emergency Contact

Emergency Contact Relationship

Emergency Contact Cell Phone

Type of Organization/Business which best describes the area(s) in which you presently work/serve.

If Type of Organization/Business is Other, Please specify

Career History- Please attach a resume in pdf format.

Accepted file types: pdf, Max. file size: 256 MB.

Have you served active duty or reserve time in the U.S. Military?

Yes

If yes, what were your dates of service?

Professional and Civic Awards and Recogntion

Please list any recognition or awards you have received, who awarded them and the date they were awarded.

What do you consider your most important professional/civic contribution and why?

In your opinion, what are the three most significant challenges facing Oakland County and/or the region?

In your opinion, what are the three most notable opportunities Oakland County and/or the region has to offer?

How would your participation help promote diversity in the makeup of the class?

How do you envision Leadership Oakland helping you achieve your leadership goals?

Do you live and/or work in Oakland County?

Live

Work

Both

What specific skills/knowledge do you hope to gain from your Leadership Oakland experience?

I am being nominated by:

Self

A graduate of Leadership Oakland

Other (please explain)

If you are being nominated by a Leadership Oakland Graduate or someone else, please list their name and email below.

Consent

I understand the selection criteria, attendance requirements and the tuition and deposit information.

SELECTION CRITERIA

Application to the LEADERSHIP OAKLAND CORNERSTONE PROGRAM is open to all persons living or working in the Detroit metropolitan area.

The class is generally limited to 50 participants who will be selected by the LEADERSHIP OAKLAND Selection Committee. The Committee will be seeking participation from a cross-section of the community. Participants should be active in business, and/or professional, educational, governmental, artistic, religious, service or community organizations.

The most important factor in selection is identifying those individuals most apt to utilize their leadership for the long-term benefit of the region. In reviewing applications, the Selection Committee looks for candidates who demonstrate the following characteristics:

• Genuine concern for the future of Oakland County and the region
• A sincere commitment, motivation and interest to serve Oakland County and the region
• Willingness and ability to make the time commitment required by the program
• The intention of seeking appointments to community boards, commissions or key volunteer leadership positions
• Representative of the diversity of the region

We strive to model and promote diversity and inclusion as a means to strengthen leadership. We do this by: respecting and encouraging all perspectives; and engaging diverse populations in all activities.

ATTENDANCE REQUIREMENT

Attendance at the retreat and at least 75% of the monthly sessions is a prerequisite for graduation.

CORNERSTONE PROGRAM TUITION

Tuition for Leadership Oakland XXXIV is $3,500 and covers all program costs and materials. A deposit of $250 is required with this application; upon acceptance to the program, it will be applied to the tuition. Tuition must be paid in full 60 days from the date of acceptance to the program, unless other payment arrangements have been made. A limited number of scholarships are available to qualified individuals who may not otherwise be able to participate. If you wish to apply for a scholarship, email a letter with the reason to info@leadereshipoakland.com. Deposits are only refunded if you are not selected to participate by the LO Selection Committee.

Reference 1

First Last

Organization

Phone

Reference 2

First Last

Organization

Phone

CORNERSTONE PROGRAM APPLICANT COMMITMENT

I agree to the Cornerstone Program Applicant Commitment

If selected as a participant in Leadership Oakland XXXIV, I will attend the Leadership Development retreat and at least 75% of the monthly sessions. I will also make an effort to attend other functions sponsored by the program. I agree to respect and abide by the rules of host locations throughout the program. I understand that if I fail to meet any part of this commitment, I may be asked to withdraw from the program without any refund of tuition. I understand that any false information may disqualify me from participation.

My employer or organization is sponsoring my enrollment in Leadership Oakland.

Yes

If you are sponsored, please provide the name, title, organization and contact information of the organization that is sponsoring you below.

Refund/Cancellation Policy

I agree to the refund/cancellation policy

REFUND/CANCELATION POLICY

Cancellations are subject to a $250 registration fee. Cancellations must be made in writing to Leadership Oakland no later than 45 days prior to the opening retreat to receive a full refund (less $250 registration fee). Cancellations after this date will be subject to a prorated refund as follows: 45-30 days 50%; less than 30 days 25% refund.

Name

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