Parents for Public Schools Leadership Institute
Application Form 2010


SELECTION CRITERIA
Participation in the Parents for Public Schools Leadership Institute is open to parents, concerned citizens, and caregivers who have or have had children in public schools. Participants will be selected on the basis of:

Participants are selected without regard to race, color, religion, sex, disability, familial status, or national origin. There is no charge for participation.

Applicants must obtain two supporting references (visit NE PLI webpage to download reference form).

2010 Location: Hancock Leadership Center, September 10-11, October 8-9, November 5-6, 2010

Name *
Street Address *
City *
Zip *
Home Phone
Cell Phone
Please indicate where you would like to be contacted. *Home Phone
Cell Phone
E-mail Address: *
Emergency Contact Name and telephone number *
Have you volunteered on the school board? *Yes
No
If yes, indicate your role and dates served.
Have you volunteered on the school site council *Yes
No
If yes, indicate your role and dates served.
Have you volunteered on a school district committee? *Yes
No
If yes, indicate your role and dates served.
Have you volunteered on the school PTA/PTSA/PTO? *Yes
No
If yes, indicate your role and dates served.
Have you volunteered with Parents for Public Schools? *Yes
No
If yes, indicate your role and dates served.
Have you volunteered with a community committee? *Yes
No
If yes, indicate your role and dates served.
Have you volunteered for a religious institution? *Yes
No
If yes, indicate your role and dates served.
Have you volunteered for a scouts, sports, childrens activities? *Yes
No
If yes, indicate your role and dates served.
Have you volunteered for other organizations? *Yes
No
If yes, indicate your role and dates served.
Employer (current) *
Position (current) *
If you have children currently in school, please indicate their name, age, grade, current school, and the school he/she will attend in Fall 2010?
If you are accepted, what school do you plan to work with during your two year commitment? *
What is/are the name(s) of the principal(s)? *
How did you find out about the PPS Leadership Institute? *
Race/ethnicity origin (optional)
Age (optional)
Tell us how you are involved in your community. *
List and explain some ways you are involved in your child(ren)s school.
Tell us about one time you demonstrated courage and were willing to question things that needed to be changed. What was the outcome? *
Tell us one time you were creative in thinking about a solution to a problem. *
Are you enthusiastic, positive, and people-oriented? *
Are you solution and action-oriented? *
Are you creative in thinking about solutions to problems? *
Are you courageious and willing to question things needed to be changed; willing to take risk based on solid information? *
Are you honest and sincere in dealings with others; a good listener and communicator? *
Are you fair-minded; treats all people with dignity and fairness; displays empathy? *
Are you a team player who is able to build trust, delegate and empower others? *
Are you dependable; sticks to commitments and follows them through to completion? *
List some issues or problems your school/school district is currently experiencing? *
What could an organized group of parents in your school or community do to improve student learning? What could make that happen? *

ATTENDANCE POLICY
Participants are required to attend all day and evening sessions and are strongly encouraged to take advantage of the overnight accommodations provided. Participants are expected to make childcare, work, and other arrangements in advance in order to attend all sessions.

PERSONAL COMMITMENT
Each participant in the 2010 Parents for Public Schools- Parent Leadership Institute (PLI) should commit to attend all three two-day meetings and commit to design and implement one project in a public school or in the community that will impact public school children. To graduate from the PLI, you are expected to attend all sessions in their entirety. Participants are also expected to continue their involvement with the Institute for two years following the training sessions, to recruit other parents for the Institute, and to share their experiences with parent engagement in their community.

I understand the purpose and expectations of the Parents for Public Schools Leadership Institute and, if accepted, agree to devote the time, participate in the meetings and conduct at least one parent project/activity in my community.

Signature (typing your name indicates that you agree to the personal commitment) *
Date *
Verification Code:
Enter Verification Code: *
* Required