United Way of

Greater Rochester

75 College Avenue

Rochester, NY 14607

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

www.uwrochester.org/aaldp

Virtual program dates: September 14, 15, 16, 17 2021

Program time: 8:30 am - 2:00 pm

Application deadline: April 30, 2021

Personal Data

United Way’s Leadership Development Program is a unique program that identifies and provides development opportunities and promotes the placement of participants in policy-making positions at community organizations in the Greater Rochester area.

The primary focus of the program is the development and application of effective leadership skills and competencies in one’s professional and volunteer pursuits. The connections, experience and relationships built throughout the program is invaluable to individuals, organizations and our entire community as we all come together to help Rochester thrive.

Due to the COVID-19 pandemic, the training will be virtual. The curriculum topics will include, but are not limited to leadership development, board membership responsibilities, diversity, equity and inclusion and alumni engagement following the program.

First Name

Middle Name

Last Name

Pronouns

Self -Identification

Preferences

Preferred Phone

Preferred Email

Preferred Address

Preferred Name

African Heritage

You must be of African Heritage to attend this program

Please select how you best describe your ethnicity:

Other ethnicity:

Address

City

State

Zip

Cell Phone

Home Phone

Personal Email

Gender

Date of Birth

Need special accommodations? please select any that apply.

Are You originally from the Greater Rochester area?

How Long Have You Lived in the Greater Rochester Area?

Which state/city are you originally from?

Employment Data (if applicable)

Employer

Job Title

Department

Employer Address

Employer City

Employer State

Employer Zip

Business Phone

Business Email

Supervisor First Name

Supervisor Last Name

Supervisor Email

General Information

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

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

Leadership Training (Please list any leadership training you may have attended in the past two years)

Name of Training

Year Started

Year Ended

Year difference

Volunteer Activities (Please list the organization and/or type of service to which you may have volunteered in the past two years)

Organization

Role

Year Started

Year Ended

Year difference

Employer	United Way's Website
Article	Television
Friend	Work Colleague
Alumni	Other

Adult Skills Development	Care for Older Adults	Legal Assistance
Older Adults	Employment Job Training	LGBTQIA+
AIDS/HIV	Faith Based	Literacy
Art (Visual/Performing)	Family Crisis	Mental Health and Counseling
Blind 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	Social Services	Substance Abuse
Dance	Homelessness/Housing	Theater
People with Disabilities	Hospice/Terminally Ill	Women's Issues
Domestic/Intimate Partner Violence	Inner City Education	Youth Mentoring
Economic Development	Youth Skills Development	Education