United Way of Greater Rochester

75 College Avenue, Rochester, NY 14607

PH: (585) 242-6400 F: (585) 242-6500

www.uwrochester.org.lldp

United Way’s Latino Leadership Development Program was established to identify, train, and promote the placement of Latinos on boards, committees, community projects, and policy–making positions in order to ensure the Greater Rochester community and organizations are tapping the full potential of the Latino community. Nonprofit board members are often passionate about the objectives of the organization, but it takes more than passion to govern a nonprofit organization. Board members must understand their role within the organization, fundraising tools and management techniques. As professionals in your field, this leadership training will help you become acclimated to your role as a volunteer, community leader, a board member and enhance your problem solving skills.

LATINO LEADERSHIP DEVELOPMENT PROGRAM APPLICATION

Personal Data

First Name

Middle Name

Last Name

Pronouns

Address

City

State

Zip

Cell Phone

Home Phone

Personal Email

Gender

Date of Birth (MM/DD/YYYY)

Other Gender Description

How Long Have You Lived in the Greater Rochester Area?

Are You Originally From the Greater Rochester Area?

Where are you originally from?

Employment Data

Employer

Job Title

Department

Employer Address

Employer City

Employer State

Employer Zip

Business Phone

Business Email

Supervisor First Name

Supervisor Last Name

Supervisor Email

Preferred Phone

Preferred Email

Preferred Address

Other Hispanic/Latino Heritage

Other Description

General Information

Why would you like to participate in this year's program?

How do you envision using the skills gained in LLDP to enhance your future professional endeavors?

Volunteer Activities (List your volunteer experience in the last three years. If you haven’t volunteered in the last three years, share any volunteer experience (i.e. community, college, non-profit, religious organization, workplace, etc.)

Organization

Role

Year Started

Year Ended

References (List four references, two must be professional.)

Reference #1

First Name

Last Name

Phone

Relationship

Reference #2

First Name

Last Name

Phone

Relationship

Reference #3

First Name

Last Name

Phone

Relationship

Reference #4

First Name

Last Name

Phone

Relationship

Argentina	Bolivian	Brazilian
Chilean	Colombian	Costa Rican
Cuban	Dominican	Ecuadorian
Guatemalan	Honduran	Mexican
Nicaraguan	Panamanian	Paraguayan
Peruvian	Puerto Rican	Salvadoran
Spaniard	Uruguayan	Venezuelan
Other

Employer	United Way's Website
Article	Television
Friend	Work Colleague
HLDP/LLDP Alum	Other

Adult Skills Development	Elder Care	Legal Assistance
Aging	Employment Job Training	LGBTQ
AIDS/HIV	Faith Based	Literacy
Art (Visual/Performing)	Family Crisis	Mental Health and Counseling
Bling or Visually Impaired	Fundraising for United Way or other organizations	Music
Children and Youth	Grant Writing	Poverty
Community Development and Planning	Health	Strategic Planning
Crime	Health and Social Services	Substance Abuse
Dance	Homelessness/Housing	Theater
Development Disabilities	Hospice/Terminally Ill	Women's Issues
Domestic Violence	Inner City Education	Youth Mentoring
Economic Development	Youth Skills Development	Education