LeadershipFPRA Application Form

APPLICATION PROCESS

• Application must be submitted electronically to the FPRA State Office by June 14, 2023.

Resume Upload *

No file chosen

• Please attach an updated copy of your resume.

LinkedIn URL *• Please link to your LinkedIn page.

Headshot Upload *

No file chosen

• Please attach a high-res color professional headshot suitable for use in publications and publicity.

• Applicants will be notified of the Selection Committee’s decision by mid-July 2023.

• Please keep in mind while the Selection Committee is evaluating individual applications, it is also building diversity – professionally and geographically – as well as age, race, gender and ethnicity.

• Tuition for LeadershipFPRA is $850. Program tuition includes meals and session/program-related costs.

PARTICIPATION REQUIREMENTS

Participants are required to attend the entire orientation and cannot not miss more than one session over the course of the program to graduate.

Tuition to be paid in full at the time of acceptance into the program.

APPLICATION INSTRUCTIONS

PART I: To facilitate the application process, please answer every question.

PERSONAL DATA

Full Name: *

First name or nickname preferred:

Company Name: *

Title: *

Business Address:

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Country

Business Phone: *

Email Address: *

Home Address:

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Country

Home Phone:

Cell Phone: *

How long have you been a member of FPRA? *

LeadershipFPRA takes pride in choosing a class that is diverse in all areas. Please provide the following demographic information:

If other, please indicate:

EDUCATION

Please list your educational and military (if applicable) achievements, including any significant awards, honors and dates attended: *

If other, please indicate:

Do you have the support of your employer for the time necessary to participate in LeadershipFPRA? *YESNO(Participants will be committing to four 1+1/2 day sessions, a 1-day session aligned with FPRA’s CN Winter Symposium in January and a 1-day extension of the FPRA Annual Conference in August. Participants are expected to be registered for the FPRA Annual Conference (separate registration and lodging fees apply).

Are you able to make the financial commitment to participate in the LeadershipFPRA program? *YESNO(It is estimated that participants should assume travel and accommodation costs of $200-$250 per session)

BUSINESS AND COMMUNITY INVOLVEMENT

LeadershipFPRA places great emphasis on the time you commit to improving your community through volunteer activities.

In order of importance to you, list up to five volunteer, community, civic, professional, business, social, athletic, religious, or other organizations in which you are currently active or have been active in the past, and in which you have assumed a leadership role and explain why it is important. (250-word limit) *0 / 250

Please describe an issue that has impacted you personally, which illustrates your successful actions as a leader within your organization and / or community. (250-word limit) *0 / 250

If you are not actively involved, what conditions have changed that now enable you to seek involvement in your community? (250-word limit) *0 / 250

FPRA AND LEADERSHIP PERSPECTIVE

LeadershipFPRA places great emphasis on the time you commit to improving your community through volunteer activities.

What about LeadershipFPRA motivated you to submit this application? (250-word limit) *0 / 250

What do you hope to gain from participating in LeadershipFPRA? (250-word limit) *0 / 250

Have you participated in a previous leadership program? Please list: *

What do you feel are the biggest challenges facing the Public Relations profession? (250-word limit) *0 / 250

How can FPRA help you with these challenges? (250-word limit) *0 / 250

PART II: REFERENCES

• Please list contact information for two persons who can comment on what you bring to the LeadershipFPRA program.

Name: *

Title: *

Business Address:

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Country

Phone *

Email: *

Your connection with this person: *

Name: *

Title: *

Reference 2

Business Address:

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Country

Phone *

Email: *

Your connection with this person: *

PART III: MISCELLANEOUS

Do you have a disability or physical limitation where accommodations or assistance would be helpful? *YESNO

If yes, please indicate:

Special Diet Request - Vegetarian meals are only available if requested IN ADVANCE.Please indicate below if you would prefer vegetarian meals or have any other dietary restrictions. Anyone failing to make special diet requests will be responsible for covering any related costs:

PART IV: COMMITMENT

By submitting this application, I understand LeadershipFPRA is much more than a six-session program and, if selected, I will be expected to continue as an active member of the association by sharing my time, talents, and resources to support LeadershipFPRA and FPRA.

I understand the purpose of the LeadershipFPRA program. If I am selected, I will devote the time and resources necessary to complete the program.

I understand the entire orientation is mandatory and even though emergencies do arise, any participant missing more than 80% of the sessions will be asked to withdraw from the program with no portion of the tuition refunded. I have the full support of my employer for the time required to participate. I agree to be bound by the above commitments by signing this application.

I agree to all statements above.I have the approval of my supervisor to participate and attend all LeadershipFPRA events and activities.

First Name: *

Last Name: *

Title: *

Email: *

Name and Contact Information for Supervisor

If you are selected to be part of the LeadershipFPRA class, FPRA State Office will be notifying your supervisor. Provide his/her contact information below:

Name: *

Title: *

Company Name: *

Email: *

Please list your Facebook, LinkedIn, Instagram and Twitter handles (if applicable): *

Describe your unique blend of personality, skills, and life experiences that you would contribute to LeadershipFPRA: *

PART V: TUITION

The cost of the LeadershipFPRA program is $750 per participant (not including travel and lodging), payable upon acceptance to the program. Tuition can be paid in full at the time of acceptance into the program or the following payment plan may be utilized.

Will you be receiving a chapter scholarship? *YESNO

Would you like to be considered for a scholarship? *YESNO

Would not receiving a scholarship prevent you from participating in the program? *YESNO

PART VI: CANCELLATION POLICY

• Prior to orientation, if you are replaced by one of the alternates, you will receive a full refund.

• Prior to orientation, but too late to be replaced by an alternate, you will receive a refund, less $100.

• After orientation, there will be no refund.

To which FPRA chapter(s) have you belonged during your membership? *

Ethnicity: *

Please check one or more of the following categories that best describes your present employment: *