Elevate Application

First Name:

Last Name:

Email Address:

Phone Number:

T-Number:

Planned Academic Major:

High School Graduation Date:

Please list your current and previous leadership roles:

Please list your volunteer or community-service involvement from 9th grade through present. If possible, please provide the number of hours earned with each activity.

Please list any relevant leadership awards, certificates, training programs, or other recognitions you have received

Applicants are not required to have held a formal leadership position or received leadership awards to be considered.

Leadership Self Assesment

Please indicate how strongly you agree or disagree with each statement using the following scale:

1 - Strongly Disagree
2 - Disagree
3 - Neither Agree nor Disagree
4 - Agree
5 - Strongly Agree

I am confident in my ability to lead others.

1

2

3

4

5

I communicate effectively with others.

1

2

3

4

5

I can manage disagreements and conflict constructively

1

2

3

4

5

I work effectively with people whose backgrounds or perspectives differ from my own.

1

2

3

4

5

I understand my personal leadership strengths.

1

2

3

4

5

I am confident in my ability to make decisions.

1

2

3

4

5

I work effectively as part of a team.

1

2

3

4

5

I intend to pursue leadership roles in the future.

1

2

3

4

5

SHORT ANSWER QUESTIONS

Please respond thoughtfully to each question. Suggested response length: 150–250 words per question.

Why are you interested in participating in the Ferguson Fellows Leadership Development Program? What do you hope to gain from the experience?

What leadership skill would you most like to strengthen, and why is developing this skill important to you?

Participant Acknowledgment

If selected for the Ferguson Fellows Leadership Development Program, I understand that I will be expected to:

· Attend all required sessions

· Arrive on time and participate actively

· Complete all required assignments and projects

· Communicate promptly with program staff regarding unavoidable absences

· Follow all applicable university and program conduct expectations

· Participate in program assessment activities

· Maintain good academic standing

I have reviewed and agree to these expectations*

Yes

Photograph and Publicity Preference

Photographs or video may be taken during program activities and used for appropriate university communications or promotional purposes. Choosing not to grant permission will not affect consideration for or participation in the program.*

I grant permission for photographs or video of me to be used for appropriate university purposes.

I do not grant permission.

Please send a recent headshot to fergusonlegacyleaders@atu.edu.

Supplemental Application Document

Please upload a brief letter of recommendation from a teacher, coach, adviser, employer, or community leader. The letter should address your leadership potential, character, dependability, or ability to contribute positively to a group.

Accepted file formats: PDF or Microsoft Word document

Applicant Certification

By submitting this application, I certify that the information provided is accurate and complete to the best of my knowledge.

Applicant Signature:

Date: