Rotary District 5010Leadership Academy

2012 – 2013 Nomination & Application FormAs space is limited, please return with tuition as soon as possible. Final date for receipt is

815/12.

Please accept the nomination of the following outstanding Rotarian to the 2012-2013 Rotary District 5010 Leadership Academy. PLEASE TYPE OR PRINT .

NAME: Last ______________________________________________________________________First ______________________________ (BADGE NAME)

ROTARY CLUB OF: ________________________________ PRESIDENT (year, if applicable): ADDRESS: Number/Street

City State/Province Postal Code CONTACT: Home Phone Work Phone Fax

Email (regular) Gmail address (required for Academy work) Number Years in Rotary Rotary Positions Held (please cite club or district and year): Special areas of Rotary interest: If selected, I agree to the requirements in the Candidate’s Agreement of Understanding.Signature of Candidate: Candidates may be nominated by the club, by a district leader or self nominated.I, hereby, nominate______________________________ (name), for the following reason(s):__________________________________________________________________________________________________________________________________________________________________________________Nominee must be approved by his/her club. By submitting this nomination, club leadership agrees to provide support to and fully collaborate with their nominee on Academy club-based assignments and consider adoption of beneficial club strategies developed through the process.

Nominator:_________________________________________ ____________________________________________

(please print name) (signature)Rotary Club: _____________________________ Phone (___) Date: ___________________________________ Email: Position (PDG, Past President, etc.): _________ Year Office Held

Candidate’s Club President:_________________________________________ ______________________________________

(please print name) (signature)Send completed nomination/application form by email or fax no later than July 31, 2012 to:

Gayle Knepper PDG

D5010 Leadership Academy Chair907-351-8076 919-714-0485 (fax)

rotary5010@ak.net21 July 2012

Rotary District 5010Leadership Academy

www.district5010leadershipacademy.org

CANDIDATE’S AGREEMENT 2012-2013The District 5010 Leadership Academy program is an seven-month series of courses and meetings designed to increase the knowledge of past club presidents, presidents-elect, presidents-nominee and other qualified Rotarians to participate in leadership at the District and club levels. Taking part in this program requires a strong commitment to complete the program, especially through the dedication of the time required, on the part of the individuals nominated to participate.

BASIC REQUIREMENTS FOR ADMISSIONPrior to admission to the Leadership Academy program, students are required to complete the following:

1. Submission of a Nomination Form by an authorized individual2. Completion of a skills survey to determine each applicant's computer, Internet, and software

capabilities3. Successful completion of the "Rotary Communications Course" including participation in the

Google Group; all required assignments and a minimum score of 70% on the final exam. Deadline for completion of this course is September 30 in order to continue on to the full Academy program for the 2012-2013 Academy year.

4. Submission of the signed Student Agreement for 2012-2013.

The Leadership Academy Technical Requirements for Participants Include the Following:1. Own a personal computer (PC or Mac) AND have significant computer skills and expertise2. Have Microsoft Internet Explorer installed for use in all Academy course work. (If working on a Mac,

Firefox or other non-Safari browser in addition to Safari.) REQUIRED3. Have a personal Gmail address to be used for Academy purposes (set up free on Google and

forward to your regular email address if you wish). REQUIRED4. Check email daily for communications from the Academy.5. Be using Windows 2000, XP, Vista or Windows 7 operating system or Mac OS 10.6 or higher.6. Have access to and successfully use Microsoft Word (or Open Office) for all Academy assignments.

REQUIRED7. Have extensive knowledge/expertise in the use of web browsers, the Internet and search engines.8. Have expertise in downloading, opening, saving and printing Adobe PDF files. REQUIRED9. Have expertise in downloading, opening, saving and printing Microsoft Word Excel and PowerPoint

files.10. Be thoroughly familiar with and capable of opening, reading, and saving all files attached to

email. 11. Be thoroughly familiar with and capable of attaching files to an outgoing email message.

REQUIRED12. Have the latest version of the Adobe Acrobat Reader (Version 10+) installed on computer (PC or

Mac). This free software may be downloaded from http://www.adobe.com/reader REQUIRED13. Be willing to download, save and print between 200-300 pages of printed material during the

year. 14. Have access to HIGH SPEED INTERNET ACCESS for all Academy work on a daily basis.

REQUIRED15. Be willing to spend 4+ days per month (depending on your reading speed, computer speed and

Internet capability) working on Academy course work (including the reading of all course materials).

16. Agree to complete all course work and exams during the 30-day period the course is taught.

17. Attend the required meetings during the year as determined by scheduling them on your calendar immediately upon acceptance for participation in the Academy program. These are the District Planning and Leadership Seminar (February 2013), District Assembly/Conference (May 2013 in Ketchikan) and a mid-year conference call.

18. VERY IMPORTANT : Students will need to perform all of their Academy course work on a computer with high speed access to the Internet which is NOT located behind a government, banking, brokerage house or other business office firewall. These firewalls usually prevent students from accessing the secured area of the Academy web site where all course work is posted. Ten years of DLA graduates can confirm that there is no work around. In addition, several of the courses require taking online tutorials that can only be accessed with a high speed connection. Students without high speed access or who are behind the above-mentioned firewalls will need to find alternative Internet access such as home or the public library or should not enroll in the Academy until they have regular unobstructed high speed Internet access.

Rotary District 5010Leadership Academy

CANDIDATE’S AGREEMENT

Please read carefully, check/initial the boxes, sign and return this form along within 7 days of submitting your Academy application, along with the $125 tuition fee made payable to Rotary District 5010. Mail to Gayle Knepper, Academy Dean, PO Box 101538, Anchorage, AK 99510. You may also email this form to Gayle at rotary5010@ak.net or fax to (919)714-0485. If you have questions, please contact Gayle at (907)351-8076. Final deadline for receipt of the agreement and tuition is August 15, 2012.

I confirm that I have read the District 5010 Leadership Academy requirements and fully understand what will be expected of me if I am confirmed to participate in the 2012-2013 Academy.

Therefore . . .□___I agree to participate in these meetings and events: District Planning and Leadership Seminar (February 2013), District Assembly/Conference (May 2013 in Ketchikan) and a mid-year conference call. □___I agree to complete all courses by their individual DEADLINES as stated in Item #16.□___I understand that failure to complete Academy courses by the deadlines, as stated for each course (without good and sufficient reason), may cause me to be dropped from the Academy program during the Academy year.□___I understand that Academy courses will only be available in the month stated and will not be available early.□___I understand I will be required to spend a approximately $35.00 of my own funds to purchase various materials from Rotary International for the assigned course work, provide my own transportation to all Academy required meetings and that there will be extensive printing of materials throughout the Academy year. This is in addition to the $125 tuition.□___I understand that high speed Internet access is required to complete all Academy work online. I confirm that I have high speed Internet access to complete all of the Academy work.

Understanding and agreeing to all of the above requirements, I submit this agreement along with the required skills survey and application and request the following:□That I be enrolled in the "Communications Course" (including the Google Group participation, Web Challenge, Assignment and final exam).□I understand that my admission to the full 2012-2013 Academy Program will be based on the survey results to ensure ability to participate in the program, my performance in the Communications Course and the final exam results. I agree to complete all course work and the final exam for the Communications Course by the September 30, 2012 deadline.

Following completion of the above, I hereby request that I be considered for full acceptance into the 2012-2013 District 5010 Leadership Academy Program. (please type or print)

Your Name: __________________________________ Rotary Club of: Your Gmail: __________________________________ Regular Email: (A Gmail address is mandatory for Leadership Academy work. Sign up free at Google.)Home Phone: ___________________ Business Phone: __________________ Fax: Mailing Address: City: ___________________________________________ State: _________ Zip:

Your Signature: ___________________________________ Date: June 21, 2012

Rotary International District 5010Leadership Academy

http://www.district5010leadershipacademy.org

Survey for Prospective Academy Candidates

Name: ______________________________ Rotary Club: _____________________________

Please complete this survey within 7 days of the application date and send by email or fax to:

Gayle Knepper, Academy Dean, rotary5010@ak.net, 919-714-0485 (fax). If you have questions, please call Gayle at 907-351-8076.

Final deadline for receipt of this survey is August 15, 2012=====================================================================================To assist the Leadership Academy in determining if you have the software needed and the computer/ internet “skills" necessary to successfully participate in and complete the Leadership Academy Program (which is an all electronic program), please provide the following information.

1. □Yes □No Do you have a personal computer at home that you can access daily?a. If you answered "yes" to Question #1, what type of computer do you have?

□PC b. □Mac2. How old is your computer or the computer you would be using for this program?

__________3. What operating system is currently running on this computer?

a. □Windows 98 (will not work for Academy use)

b. □Windows 2000

c. □Windows XP

d. □Windows Vista

e. □Windows 7

f. □MAC OS - What Version ______________4. Please rank your personal computer use and "expertise". (Past Academy Graduates are in

agreement that an “intermediate” expertise level is the minimum required to assure success in the Leadership Academy.)

a. □Casual User (email only but not on a daily basis. Computers are not in your "comfort zone" and you do not use them in your professional work.)

b. □Beginner (daily email with occasional Internet use. Not software proficient. Still somewhat uncomfortable with computers and the Internet but you are learning.)

c. □Intermediate (daily email, daily internet, frequent use of Word & Excel. Still learning but very comfortable with all of these components.)

d. □Advanced (daily email, internet; proficient in Word, Excel, PowerPoint and other software. Significant part of your daily life and very comfortable using computers.)

e. □Super User (Use a computer daily for all aspects of your professional and personal life andare highly proficient in the use of email, MS Word, MS Excel, PowerPoint, Adobe Acrobat, the Internet and various search engines. Could not get through the day without them. You have significantly above average "technical expertise" and often help others having difficulty.)

5. Which web browser do you use?

a. □Microsoft Internet Explorer (required for Academy use. If you are a Mac user, you should have one of the browsers listed below in addition to Safari.)

b. □Firefox

c. □Opera

d. □Google Chrome

e. □Mozilla

f. □ Other. (Please indicate) _______________________

6. What type of Internet Access do you have at the location at which you will be doing your Academy work?

a. □DSL / High Speed Cable / High Speed Wireless

b. □T-1 Line

c. □Dial-Up (Dial up access will not work for Academy use. If this is the only type of access you have, please identify another location to do your Academy work such as the public library. You will not be able to participate until you have high speed access.)

7. If you plan on doing your Academy work at your place of business, do any of the following apply to you?

a. □Government Agency (local, state, federal)

b. □Financial Institution (bank, credit union, investment firm, brokerage house, etc.)

c. □Non-profit Agency

d. □Other business with extensive firewalls in place.(If any of the above apply and you do not have access to another high speed location, you may not be able to participate in the program. The Academy web site is a "secured" site requiring user ID and password access that may be restricted by your server. If you work at any of the above, you will likely not be able to access the site to obtain your coursework.)

8. What is your personal email address? ___________________________________

9. Do you have a personal Gmail address? (required for Academy enrollment; sign up free at Google)

a. □Yes □No b. If you answered "Yes", enter your Gmail address here:

_____________________________

10.□Yes □No Do you check your email daily? More than once? □Yes □No

11.□Yes □No Do you own Microsoft Word? (Required for all Academy work. All courses use

"Fillable Word Templates" that cannot be completed with other software.You may also use the free "Open Office" software to complete this work.)

12.□Yes □No When using the Internet do you know how to enter a web site URL into thebrowser's address line?

13.□Yes □No Do you know how to "copy and paste" content from one document to another

or from the Internet into a document?

14.□Yes □No Do you have either Adobe Acrobat (Ver. 9 or 10) or the latest version of the

Adobe Reader (10.0.1 or higher) currently installed on your computer?

15. □Yes □No Do you know how to set up file folders on your computer?

16. □Yes □No Are you able to download, open, read, and print Adobe PDF files?

17.□Yes □No Do you know how to download files (PDF, Word, Excel, etc.) from the Internet

and save them to your computer (in a folder) so you can find them later?

18.□Yes □No Do you know how to open Email attachments (Word, Excel, PDF, etc.) and save

them to your computer in a specific folder for later use?

19.□Yes □No Do you know how to complete "Fillable Word Documents" then save them to

your computer in a specific folder for later use?

20.□Yes □No Do you know how to create Word documents using specific formatting (as

provided in course instructions), then save the document to your computer for

later use?

21.□Yes □No Do you know how to attach files to outgoing email (Word, PDF, Excel, etc.)?

22.□Yes □No If admitted to the Academy, you will be required to purchase approximately

$35 worth of printed material from Rotary International. Are you willing to

do this? (This is in addition to the tuition.)

23.□Yes □No In addition to the printed materials from RI, a significant amount of additional

material will be posted to the Academy web site for each course during theyear. This will entail downloading and printing from 200-300 additional

pages.Are you willing to do this?

24. Description of Your Computer ProficiencyAs the Leadership Academy program is an intensive all electronic program, it is very important that all candidates have the required skills and tools in order to be able to successfully access the required web sites, locate information on the Internet, and use Word, Excel, PowerPoint and PDF files to complete their course work. Please explain your computer and internet proficiency, how long you have been using computers and the Internet and your level of proficiency in the use of the software programs mentioned above. (Be specific.) You may attach a separate document to complete this portion of the survey.