Adult Learner Leadership Institute – (Northern or Southern) California
Application for Participant
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Return completed application to:
Directions: Please answer all questions completely in the space provided.
Your completed application must be received no later than .
Please have your coordinator submit the completed application to:
(Library Literacy Program Name-ALLI boot camp site)
Attn:
Address
Fields with red boarders are required.
City Zip
Or fax to
example 5555555555
Or Email to
(Please print clearly or type)
Name:
Address:
City:
Zip Code:
Phone:
example 5555555555
Library:
Literacy Coordinator Signature:
1.
What does leadership mean to you?
2.
Why do you feel you should be a part of the Adult Learner Leadership Institute?
3.
Why do you think the Institute is important?
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Participant Application – Adult Learner Leadership Institute – Northern 0r Southern California
4.
How will you help other adult learners in the Institute and your program?
5.
Have you been involved with your literacy program? If yes, how?
6.
Are you able to attend all three days of the Institute?
7.
What else would you like us to know about you?
As a participant in the Adult Learner Leadership Institute you must be willing to have
your picture and video taken for publicity and for the California State Library report. By
signing this application you are consenting to being a participant and being
photographed and/or videotaped.
I agree to be photographed and/or videotaped for publicity purposes as part of my
commitment to the Adult Learner Leadership Institute.
Applicant’s Signature:
Date: