Community Leadership Accelerator 2024—Registration and Getting to Know You Survey

Instructions

Thank you for making the decision to invest in your leadership and community. We are excited that you are taking this important step! If you have not already, please share information about this program with other leaders who you think would be a good fit.

We have designed the registration/getting to know you survey to learn more about who you are as a person and a leader. Please answer as honestly as you can.

Each year, we work to identify community partners who can help provide financial assistance. Funds vary and can be requested through the registration process. The scholarship application link can be found at the end of this registration. Resources are limited, so please only ask for what you need.

The CLA registration deadline is midnight on February 29. We will be reviewing registrations and scholarship requests in early March, with the goal of confirming your participation in the program by March 8, 2024.

In the meantime, please hold the following dates:

Opening Retreat: April 17, 18, and 19
Virtual workshops: 9-12:30 on May 17, Jul 19, Aug 16, Sept 13
Closing retreat: October 23, 24, and 25

The opening and closing in-person retreats will take place at the Sonoran Desert Inn and Conference Center in Ajo, Arizona

In community,

Bryn Jones, Elan Consulting

Sarah Griffiths, Sarah L. M . Griffiths

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* 1. Tell us a bit about yourself:

Name:

Organization(s):

Position(s):

Age:

City where you work:

City where you live:

Rural or urban:

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* 2. Contact information

Mailing Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 3. Name you want to be called

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* 4. What is your gender identity?

Woman

Man

Genderqueer or non-binary

Agender

Prefer not to respond

Other (please specify)

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* 5. What is your sexual orientation? Check all that apply.

Asexual

Bisexual

Gay

Heterosexual or straight

Lesbian

Pansexual

Queer

Prefer not to respond

Other (please specify)

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* 6. What is your racial or ethnic identity? (Select all that apply.)

African-American/Black

East Asian

Hispanic/Latinx

Middle Eastern

American Indian/Hawaiian or Alaskan Native/Indigenous within US

Indigenous outside of US

Pacific Islander

South Asian

Southeast Asian

White

Prefer not to respond

Other (please specify)

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* 7. Are you a person living with a disability, or differently abled?

Yes

Prefer not to respond

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* 8. If you answered yes above, please tell us a little more about how we could support your full participation in CLA.

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* 9. Is English your first language?

Yes

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* 10. Why are you interested in this program? What do you want to get out of it?

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* 11. Tell us a little about the personal and/or professional development that you've done to date.

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* 12. Describe where and how you currently show up as a leader.

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* 13. Describe where and how you previously have shown up as a leader.

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* 14. On a scale of 1-10 (10 being your ideal), how would you rate your work/life integration/balance?

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 15. On a scale of 1-10 (with 10 being the most ready), how ready are you for self-exploration?

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 16. When you think of yourself as a whole organizational and/or community leader, what 3 areas would you most like to develop in yourself?

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* 17. What strengths, qualities, and/or gifts do you bring to your leadership?

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* 18. If you were feeling most effective and authentic as a leader, what might that look and feel like?

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* 19. This is a program aimed at developing diverse leaders who are grounded in their own leadership, can sustain themselves as leaders, value human connection and relationships, and can drive community change. What community change are you working towards and/or would like to work towards?

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* 20. Choose the number that best represents where you feel you are currently (1 is low. 10 is high). How would you rate yourself?

	1	2	3	4	5	6	7	8	9	10
Overall confidence level as a leader	Overall confidence level as a leader 1	Overall confidence level as a leader 2	Overall confidence level as a leader 3	Overall confidence level as a leader 4	Overall confidence level as a leader 5	Overall confidence level as a leader 6	Overall confidence level as a leader 7	Overall confidence level as a leader 8	Overall confidence level as a leader 9	Overall confidence level as a leader 10
Managing conflict	Managing conflict 1	Managing conflict 2	Managing conflict 3	Managing conflict 4	Managing conflict 5	Managing conflict 6	Managing conflict 7	Managing conflict 8	Managing conflict 9	Managing conflict 10
Maintaining a positive outlook	Maintaining a positive outlook 1	Maintaining a positive outlook 2	Maintaining a positive outlook 3	Maintaining a positive outlook 4	Maintaining a positive outlook 5	Maintaining a positive outlook 6	Maintaining a positive outlook 7	Maintaining a positive outlook 8	Maintaining a positive outlook 9	Maintaining a positive outlook 10
Admitting what you don't know	Admitting what you don't know 1	Admitting what you don't know 2	Admitting what you don't know 3	Admitting what you don't know 4	Admitting what you don't know 5	Admitting what you don't know 6	Admitting what you don't know 7	Admitting what you don't know 8	Admitting what you don't know 9	Admitting what you don't know 10
Practicing active listening	Practicing active listening 1	Practicing active listening 2	Practicing active listening 3	Practicing active listening 4	Practicing active listening 5	Practicing active listening 6	Practicing active listening 7	Practicing active listening 8	Practicing active listening 9	Practicing active listening 10
Asking more questions	Asking more questions 1	Asking more questions 2	Asking more questions 3	Asking more questions 4	Asking more questions 5	Asking more questions 6	Asking more questions 7	Asking more questions 8	Asking more questions 9	Asking more questions 10
Expressing gratitude	Expressing gratitude 1	Expressing gratitude 2	Expressing gratitude 3	Expressing gratitude 4	Expressing gratitude 5	Expressing gratitude 6	Expressing gratitude 7	Expressing gratitude 8	Expressing gratitude 9	Expressing gratitude 10
Being open to risks	Being open to risks 1	Being open to risks 2	Being open to risks 3	Being open to risks 4	Being open to risks 5	Being open to risks 6	Being open to risks 7	Being open to risks 8	Being open to risks 9	Being open to risks 10
Taking action	Taking action 1	Taking action 2	Taking action 3	Taking action 4	Taking action 5	Taking action 6	Taking action 7	Taking action 8	Taking action 9	Taking action 10
Developing others as leaders	Developing others as leaders 1	Developing others as leaders 2	Developing others as leaders 3	Developing others as leaders 4	Developing others as leaders 5	Developing others as leaders 6	Developing others as leaders 7	Developing others as leaders 8	Developing others as leaders 9	Developing others as leaders 10
Having awareness of and managing emotions (in yourself)	Having awareness of and managing emotions (in yourself) 1	Having awareness of and managing emotions (in yourself) 2	Having awareness of and managing emotions (in yourself) 3	Having awareness of and managing emotions (in yourself) 4	Having awareness of and managing emotions (in yourself) 5	Having awareness of and managing emotions (in yourself) 6	Having awareness of and managing emotions (in yourself) 7	Having awareness of and managing emotions (in yourself) 8	Having awareness of and managing emotions (in yourself) 9	Having awareness of and managing emotions (in yourself) 10
Having awareness of and managing emotions (in others)	Having awareness of and managing emotions (in others) 1	Having awareness of and managing emotions (in others) 2	Having awareness of and managing emotions (in others) 3	Having awareness of and managing emotions (in others) 4	Having awareness of and managing emotions (in others) 5	Having awareness of and managing emotions (in others) 6	Having awareness of and managing emotions (in others) 7	Having awareness of and managing emotions (in others) 8	Having awareness of and managing emotions (in others) 9	Having awareness of and managing emotions (in others) 10
Managing time effectively	Managing time effectively 1	Managing time effectively 2	Managing time effectively 3	Managing time effectively 4	Managing time effectively 5	Managing time effectively 6	Managing time effectively 7	Managing time effectively 8	Managing time effectively 9	Managing time effectively 10
Setting and maintaining boundaries	Setting and maintaining boundaries 1	Setting and maintaining boundaries 2	Setting and maintaining boundaries 3	Setting and maintaining boundaries 4	Setting and maintaining boundaries 5	Setting and maintaining boundaries 6	Setting and maintaining boundaries 7	Setting and maintaining boundaries 8	Setting and maintaining boundaries 9	Setting and maintaining boundaries 10
Taking care of yourself (mind, body, spirit)	Taking care of yourself (mind, body, spirit) 1	Taking care of yourself (mind, body, spirit) 2	Taking care of yourself (mind, body, spirit) 3	Taking care of yourself (mind, body, spirit) 4	Taking care of yourself (mind, body, spirit) 5	Taking care of yourself (mind, body, spirit) 6	Taking care of yourself (mind, body, spirit) 7	Taking care of yourself (mind, body, spirit) 8	Taking care of yourself (mind, body, spirit) 9	Taking care of yourself (mind, body, spirit) 10
Understanding yourself as an authentic leader	Understanding yourself as an authentic leader 1	Understanding yourself as an authentic leader 2	Understanding yourself as an authentic leader 3	Understanding yourself as an authentic leader 4	Understanding yourself as an authentic leader 5	Understanding yourself as an authentic leader 6	Understanding yourself as an authentic leader 7	Understanding yourself as an authentic leader 8	Understanding yourself as an authentic leader 9	Understanding yourself as an authentic leader 10
Collaborating and sharing leadership	Collaborating and sharing leadership 1	Collaborating and sharing leadership 2	Collaborating and sharing leadership 3	Collaborating and sharing leadership 4	Collaborating and sharing leadership 5	Collaborating and sharing leadership 6	Collaborating and sharing leadership 7	Collaborating and sharing leadership 8	Collaborating and sharing leadership 9	Collaborating and sharing leadership 10

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* 21. All meetings will take place during the work-week. The opening and closing in-person retreats will take place at the Sonoran Desert Inn and Conference Center in Ajo, Arizona.

Outlined here are the program components:

Program: 6-month program with around 20-25 participants from Southern Arizona, Phoenix and all the communities between and around. We will also be opening a few slots to out of state participants.

April 2024: 3-day in-person opening retreat:

4/17: 12:00 – 5:00

4/18: 9:00 – 5:00

4/19: 9:00 – 2:00

Virtual Workshops:

5/17: 9:00 - 12:30

7/19: 9:00 - 12:30

8/16: 9:00 - 12:30

9/13: 9:00 - 12:30

October 2023: 3-day in-person closing retreat:

10/23: 12:00 – 5:00

10/24: 9:00 – 5:00

10/25: 9:00 – 2:00

Other components:

EQ Assessment and debrief

Practicum—applying the principles in action—which culminates in a Leadership Memoir (required for completion of the program)

Two coaching sessions with each leader (one of which will be EQ debrief)

Participation in peer application circles

Homework, including pre-reading, practices and assessments

Are you willing and able to commit to participating in all program components?

Yes

I would like to have more conversation with you about this

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* 22. Are you holding all the dates (above) in your calendar pending acceptance into the CLA? Please do!

Yes

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* 23. Have you spoken to your supervisor and let them know the dates and times that you will be committing to the Community Leadership Accelerator (pending acceptance)?

Yes

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* 24. Do you have your supervisor's support?

Yes

Unsure

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* 25. What supports, if any, might you need to be able to fully participate?

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* 26. Do you have any dietary needs that we should be aware of as we plan meals for the in-person retreats?

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* 27. Would you be willing to share a room during the in-person opening and closing retreats?

Yes

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* 28. What else, if anything, would you like us to know?

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* 29. The cost of the program is $4,000 per person per year. This amount does not cover lodging cost or meals during the retreats. The EQ assessment, all curricula and materials, and snacks and refreshments during the retreats are included.

Cost for the in-person retreats can be managed in creative ways: sharing a room, camping etc. However, we understand that this is an investment and have given some time to think of ways to fund participation:

Your organization covers the cost

You share a portion of the cost with your organization

You pay yourself

You raise funds for part of the cost

We provide some support

Scholarships may be available and can be requested. If you've already been informed that your organization or a community partner is sponsoring you, you don't need to apply for assistance.

We ask those who need assistance to pay the highest amount you or your organization can reasonably afford. That way we can support others and their needs too.

With that in mind, will you need a scholarship? (The link to the Scholarship Application is on the next page of this application).

Yes

A community partner is sponsoring me

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50% of survey complete.