2009 Voices Institute National Leadership Program Application

2009 Voices Institute National Leadership Training Application

Racine Wisconsin, September 27-October 3, 2009

Application Due May 22, 2009

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Online Training Application

Sponsoring Organization:

Applicant's Full Name:

Address (include apt.#):

City:

State:

Zip:

Email Address:

Cell Phone:

Home Phone:

Work Phone:

Why are you applying to the Institute?

What do you expect to gain from this experience?

What type of setting do you work in? (Examples: nursing home, group home, private residence, hospital, vocational site)

Please briefly explain how you meet the following criteria

1. Employed as a direct care worker (tell us your job title and when you work):

2. Recommended and/or nominated by a direct care worker association or a workforce coalition: (Preference given to workers in leadership positions)

3. Demonstrated commitment to active involvement in an advocacy campaign at the state or national level and coordination with DCA's National Advocacy Director:

4. Access to computer and email:

5. If you've had leadership training before, tell us about it (helpful but not required):

The Second annual Voices Institute National Leadership Training consists of:

  1. Orientation and Preparation. After selection, participants take part in a leadership survey/assessment and a series of one-hour introductory sessions by telephone conference and online. These preparatory sessions will total approximately 10 hours.
  2. In-Person Training. Attend the intensive five-day leadership development training.
  3. Follow-Up Support. Receive mentoring/coaching in the context of an ongoing advocacy/organizing campaign.
  4. Recruiting and Involving Others. Help recruit and support state leaders to participate in state-level Voices Institute trainings.

I AGREE to participate in all four stages.

Todays date: