LACE APPLICATION — Center for Character & Citizenship

leadership academy application

complete form to apply for participation in lace or ceel

PERSONAL INFORMATION

Name

First Name

Last Name

Nickname

Preferred Phone Number

(###)

###

####

City

State

ZIP Code

PROFESSIONAL INFORMATION

School Name

TItle

Current Position

Work Email

Work Phone Number

(###)

###

####

School Street Address

School City

School State

School ZIP

Total Years Working in Education

Total Years as Teacher

Total Years as Assistant Principal

Total Years as Principal

Total Years as Counselor

INSIGHT QUESTIONS

What do you hope to gain from your experience with the leadership academy?

Does your school currently have an intentional character education initiative?

What is (or will be) your role in character education in your school?

What are the barriers (past, present, future) to implementing character education in your school?

How will you arrange for your responsibilities to be covered when you are out of your building to attend the monthly meetings?

Do you have any special needs for participation in the academy?

Yes

If you answered 'Yes' to special needs, please describe.

Letter of Support - Enter name of supervisor who will provide letter of support

NOTE: A letter of support for participation is required. Please have your immediate supervisor send a signed letter to ccc@umsl.edu. Your application will not be considered without the letter.

Is there anything else you would like to add?

NOTE: A letter of support for participation is required. Please have your immediate supervisor send a signed letter to ccc@umsl.edu. Your application will not be considered without the letter.

A CCC staff member will be in touch with you after you submit the application and the letter of support. Please e-mail us at ccc@umsl.edu if you have any questions.

Congratulations on taking the first step towards realizing all the positive possibilities character brings not only to your professional life, but as a person as well.