2025 LeadingAge Ohio Leadership Academy Application

STEP 1: Applicant & Applicant's Employer Information:

First Name
Last Name
Name for Name Badge
Preferred Pronouns (she/her, he/him, they/them, etc.)
Title
LeadingAge Ohio Member Organization
Organization Address
 
City
State
Zip
Email
Work Phone
Mobile Phone
Select the area of the continuum that best describes the site or community where you are employed/where you perform your primary job responsibilities:
Adult Day Services
CCRC/Life Plan Community
Corporate Office
HUD/Affordable Housing
Home Health/Home Care Agency
Hospice/Palliative Care
PACE
Assisted Living (non CCRC)
Nursing Home (non CCRC)
Housing/Independent Living (non CCRC)
Other (Please specify.)

STEP 2: Summary of Qualifications

Please provide a brief description of your experience in aging services and your current position.
What characteristics make your organization unique? (examples: urban/rural; services provided; special populations served; innovative programming)
Are you involved in other organizations/activities that would help describe you and/or your leadership potential?
Do you intend on remaining employed with a LeadingAge Ohio member for the duration of the LeadingAge Ohio Leadership Academy?
I acknowledge that if at any time my employment status changes, I am no longer employed by the supporting organization or I fail to meet any of the program’s eligibility criteria, continued participation in the Leadership Academy is subject to review by LeadingAge Ohio.
I acknowledge that I must submit a resume to rhamill@leadingageohio.org that includes at least three of my most significant formal and/or informal leadership roles throughout my career that have contributed to leadership development, educational background and other pertinent information.

STEP 3: References:

I acknowledge that I am required to obtain two letters of reference and send to rhamill@leadingageohio.org. Please approach selected references early in the process to ensure their letters are completed and submitted prior to the December 6, 2024 deadline.

STEP 4: Applicant Statement of Commitment:

The Applicant Statement of Commitment provides the basis for a commonly held understanding between the applicant and LeadingAge Ohio about eligibility criteria and participant expectations.
If selected, I agree to:
• Attend each of the four, two-day sessions. Exceptions must be requested by a letter written by the sponsoring organization to LeadingAge Ohio.
• Complete all readings and assignments, including group projects, journaling, and action learning projects to enhance the understanding and application of the content areas.
• Connect monthly with the LeadingAge Ohio Leadership Academy coaches to discuss assignments, ongoing development of action learning projects and further explore learning concepts.
• If for any reason I am unable to meet any of the participation or assignment obligations, I will notify the appropriate Leadership Academy Design Team member/s in a timely manner to discuss alternate arrangements to ensure I meet the program’s participation expectations.
• I understand that if at any time during the program year my employment status changes, I am no longer employed by my sponsoring organization or I fail to meet any of the program’s eligibility criteria, my continued participation in Leadership Academy is subject to review by LeadingAge Ohio.
I am agreeing to the terms and conditions for the Statement of Commitment indicated above.
Initials of Applicant

STEP 5: Sponsoring Organizations Statement of Commitment:

In addition to this application, you are required to submit a Statement of Commitment via email from your sponsoring organization (where you work). The Statement of Commitment from the sponsoring organization should include confirmation of the objectives below and emailed to rhamill@leadingageohio.org by December 6, 2024.
Sponsoring Organization agrees to:
• Support the participant in completing those activities outlined in their Statement of Commitment. (See above)
• Provide tuition, travel and lodging costs associated with the program.
• Allow adequate time for the completion of assignments that will enhance the understanding and application of the content areas of each session.
• Allow the participant sufficient time to connect with his or her coach and actively participate in distance learning activities.
• Meet with the participant periodically throughout the Academy experience to learn how they are applying leadership concepts and planning for their action learning project.
The Sponsoring Organization’s Statement of Commitment must be signed by the CEO or Executive Director of the applicant’s supporting organization. If the applicant is the highest ranking executive officer, the organization’s board chair must complete form.

*Written confirmation should be provided to rhamill@leadingageohio.org no later than December 6, 2024.*

STEP 6: Leadership Essay:

Please write your leadership essay by addressing the following questions:
1. Describe the qualities that make you an effective leader and how you've applied them in your personal and professional life. Include a significant professional achievement, your role in it, and its impact on your organization.
2. Describe the perspective and knowledge you hope to gain from the Leadership Academy program and how these insights will help you become a transformational leader.
3. Describe your commitment to aging services, your journey into the field, and your vision for the future of aging services.
4. If desired, add any information you believe will help affirm your commitment to leadership growth.
   - denotes required fields

Our national partner, LeadingAge, is an association of 6,000 not-for-profit organizations dedicated to expanding the world of possibilities for aging. Together, we advance policies, promote practices and conduct research that support, enable and empower people to live fully as they age.