SLC Certificate Application

Items marked with an asterisk are required.

Your application will be submitted to Human Resources for review and approval. Approval will be made by Human Resources, and acceptance communication will come from the UD Center for Leadership.

September

July

April

January

Expected start date:

Expected start date

Your name:

Title:

Organization:

Address:

City:

State:

Zip Code:

Email address (please be sure this is an email address you can access outside of work hours, in case of a weather or other emergency):

Phone number:

UD Employee ID#:

Supervisor Name:

Supervisor Title:

Supervisor Email:

Supervisor Phone Number:

Dean/VP Name:

Cost to division/department: $500 charged to account number:

Yes

I have my supervisor's approval to attend the Supervisor Leadership Certificate Program at UD Center for Leadership

Yes

I am a UD benefits eligible employee who works 1,000+ hours a year.

List any degrees you have received and the awarding institution:

Briefly state your present job responsibilities, time at the current organization and position, and number of direct reports:

If applicable, list your three previous titles and employers:

Briefly state three of your strengths:

Briefly state three areas that need further development:

In 250 words or less, explain why you want to participate in this program:

My employer will be financing.

I will be financing.

Financing:

If you have a mentor, please enter his/her name, title and contact information.

Submit

CONTACT

Center for Leadership

300 College Park
Dayton, Ohio 45469 - 7025

937-229-3115
Email

UD Employee SLC Application

SLC Certificate Application

Center for Leadership