Online Application - Ottumwa Leadership Academy

2023-24 Class Participation Application

Completion of this application is required to be considered for class participation. All information is confidential. Class size is limited. Participants are selected based on leadership potential and demonstrated community interest. Candidates who are not selected are encouraged to apply again for future classes.

Fill in this online form or email downloadable version to: htometich@leadottumwa.org or mail to 111 East Main Street.

Deadline: June 30, 2023

"*" indicates required fields

Name*

First Last

Nickname

Gender*

D.O.B*

Years living/working in Wapello County*

Home address*

Street Address Address Line 2 City State ZIP Code

Cell Phone*

Personal email*

Current Employer

Title

Work address

Street Address Address Line 2 City State ZIP Code

Work phone

Work email

Personal References

Name

Company

Phone

Use the plus sign (+) on the right to add additional rows (up to 3 rows max).

Community Leadership

(Describe present or past volunteer community leadership positions you have held)

Community Leadership

Organization

Date(s) Involved

Position/Responsibility

Use the plus sign (+) on the right to add additional rows (up to 3 rows max).

Work Experience

(Begin with most recent)

Work Experience

Employer

City/State

From/To

Position/Responsibility

Use the plus sign (+) on the right to add additional rows (up to 3 rows max).

Education

(Begin with most recent)

Education

School

City/State

From/To

Degree

Use the plus sign (+) on the right to add additional rows (up to 3 rows max).

Other Activities and Accomplishments

(List any other honors, offices held, activities, etc.)

Other Activities and Accomplishments

Essay Questions

(In answering the following questions, limit total attachments to two, single-spaced typed pages)

What do you hope to gain from the Leadership Academy experience? How do you expect to utilize this experience? What initiatives/organizations might you want to invest time in?*

What have you found to be your most challenging community involvement? And why?*

What do you feel are the two most pressing problems facing Ottumwa (and Wapello County) today?*

Leadership styles vary in different situations. In your opinion, what common traits do all leaders exhibit?*

Assess your current leadership skills. What are your strengths? What areas you would like to improve? Please provide personal examples of each.*

Application and Participation Agreement

Signature*

Date*

Acknowledgement by Employer

The undersigned, as the Employer of the applicant acknowledges:

Signature*

Date*

Available Scholarships

The Andy Hansen Legacy Scholarship

Andy Hansen was Plant Manager at John Deere Ottumwa Works from 2010-2013. While in Ottumwa, Andy provided leadership and encouraged others to step into leadership roles. He demonstrated his leadership through volunteerism and being a board member to several community organizations including the Legacy Foundation. The Legacy Foundation wanted to honor Andy’s dedication to the betterment of the Ottumwa community by creating the Andy Hansen Legacy Scholarship. This scholarship is for one year’s tuition for a participant from a non-profit organization or small business that might not otherwise be able to send someone.

The Andy Hansen Legacy Scholarship

The Alumni Association Scholarship

The Alumni Association Committee saw the need for an additional scholarship and set up an annual fund to address the issue. Selection for this scholarship is based on answers to the essay questions by a committee of alumni.

Please indicate whether your participation is reliant upon receiving this scholarship*

Yes, I need a scholarship

No, I do not need a scholarship

Note: This will not determine the recipient of the scholarship, rather it will help the selection committee better analyze the applicant pool.