CLCV™

Section 2: Student Information

Skip this section if you are not currently a full-time or part-time student.

Section 3: Employment Information

Skip this section if you are a full-time student.

Section 4: Employer Agreement (If Applicable)

Skip this section if you are a full-time student.

Because a portion of the CLCV^TM sessions are held during normal business hours, the support of your employer/organization is imperative. The applicant is expected to obtain this support, and completion of this section indicates the applicant has done so. Your supervisor and/or head of your business or organization may be contacted. All active service members are required to submit a letter of support from their commanding officer acknowledging the time commitment of the program in addition to the Employer Agreement.

Section 5: Person who referred you to CLCV^TM(If different from above)

Skip this section if you are self-nominating.

Please list the individual within your network (organization/professional/personal) who has been the most influential in your decision to apply to the Community Leadership Course for Veterans^TM program. In the event of your acceptance into the program, this individual, along with the person listed in the Employer Agreement section above, will be extended an invitation to join you at the CLCV^TM Graduation Reception at the end of the program.

Section 6: Civilian Professional/Educational Background

Please answer the professional/education background section OR attach your resume to the application.

Civilian Professional Experience (If Applicable)

List past and present employment highlights including employer, job title, a brief job description, and dates of employment.

Note: Should your education status change after you have submitted your application, please call the Leadership Pittsburgh Inc. office at 412.392.4505 and email Krissy@lpinc.org so that this information can be presented to the CLCV^TM Selection Committee.

Civilian Work Experience 1 (most recent)

Civilian Work Experience 2

Civilian Educational Experience (If Applicable)

List civilian educational highlights and include dates, coursework completed, degrees or certificates obtained, fields of study, training programs, and awards. List any educational activities ongoing at the time of application.

Note: Should your education status change after you have submitted your application, please call the Leadership Pittsburgh Inc. office at 412.392.4505 and email Krissy@lpinc.org so that this information can be presented to the CLCV^TM Selection Committee.

Civilian Educational Activity 1 (most recent)

Civilian Educational Activity 2

Professional Activities

List, in order of importance, the employer-related or professionally based activities in which you participate or have participated. For each activity, state the nature of your participation including leadership positions held, special recognition received, and the date(s) of your involvement.

Professional Activity 1

Professional Activity 2

Section 7: Military Professional/Educational Background

Please include a DD Form 214 (Member-1 copy) with your application as proof of your military service. If a DD Form 214 cannot be obtained, please submit a current ERB or ORB instead. *PLEASE BLACK OUT YOUR SOCIAL SECURITY NUMBER – we do not want/need/require this information.* Only applicants without a dishonorable discharge will be considered for CLCV^TM. If you received a discharge from the military that was less than honorable, please include a brief description of the reason for your discharge. Application materials are confidential and will be shared only with the small group comprising the CLCV^TM Selection Committee.

Military Work Experience 1 (most recent)

Military Work Experience 2

Military Educational Experience

List civilian educational highlights and include dates, coursework completed, degrees or certificates obtained, fields of study, training programs, and awards. List any educational activities ongoing at the time of application. Any changes to this post submission of application should be reported to LPInc. per above.

Military Educational Activity 1 (most recent)

Military Educational Activity 2

Section 8: Community Involvement

List, in order of importance, the community and civic (including faith-based) service activities in which you participate or have participated. For each activity, state the nature of your participation, including leadership positions held or special recognition received.

Community Activity 1

Community Activity 2

Community Activity 3

Please list the names, phone numbers and email addresses of two individuals who could attest to your leadership capabilities. These could be the people who are writing letters of recommendation or could be other people in your network.

Reference #1

Reference #2