Coach Application: Fall 2008


No Tuition
Applications due August 1, 2008


PERSONAL INFORMATION:
Name:
Home address:
City:
Zip:
Work phone:
Home phone:
Cell phone:
E-mail address:

The GLC has permission to share contact information with classmates
(Check one. GLC does not sell or share our database.) Yes No


Date of Birth (optional) mm/dd/yy:

Race/Ethnicity (this information is requested by some funding agencies):
African American
Asian American
Arab American
Latino
Native American
White
Multi Ethnic
Other

Gender: Female Male Transgender

Neighborhood Association or organizational affiliation (if applicable):



SHORT ANSWER QUESTIONS:


Thank you for taking the time to fill out our application. Please tell us a little more about yourself by answering the following questions. Your answers do not need to be long – no more than a few sentences.

Why would you like to be a coach for a developing grassroots leader?



Have you ever been mentored or coached by someone, formally or informally?
Yes No


If so, what did you like about the experience?



What did you dislike about the experience?



What do you think are some important skills needed to effectively coach a developing leader? Which of these skills do you bring to our program? What skills would you like to improve upon while a coach for the Grassroots Leadership College?



Describe interests or experiences (work, volunteer, or personal) that have prepared you for this role.



Could you commit 3-5 hours/week to the GLC?    Yes No


Do you know of other individuals who might be interested in this program, either as a coach or developing leader? Please include their names and contact information so that we can contact them.



ADDITIONAL NEEDS:


The GLC will provide childcare, transportation, and meals for our participants, as well as other accommodations that make participation possible. Please let us know of any special needs you may have.

Childcare needs (children's names and ages):


Transportation needs:

Dietary needs (vegetarian or other):

Other needs:


To electronically submit your completed application click the "submit" button
or print out your completed application and mail it to: Grassroots Leadership College,
1321 E. Mifflin St. Suite 201, Madison WI 53703.