Application for the Assessment Leadership Academy

We anticipate admitting about 35 professionals to the 2017-2018 Academy. Applicants apply individually, but must have campus support.

Applications are to be submitted on-line and are due by February 15, 2017. Applicants will be notified of acceptance decisions on or about March 1, 2017; accepted applicants will immediately receive curriculum materials, a schedule, assignments, and related Academy information.

Please be sure to review the description of the Assessment Leadership Academy and FAQs and also consider carefully the schedule, requirements, and expected participation before submitting an application.

First Name *

Last Name *

Academic degrees earned *

Current Position Title *

Current Institution *

Email *

Office Phone *

Cell Phone *

Home Phone

Mailing Address *

Mailing address, line 2

City *

State *

Zip code *

Describe your higher education professional experience *

Include position titles, dates, and institutions.

Describe your reasons for interest in the Academy *

Describe your assessment experience, including assessment leadership roles *

Describe other examples of your leadership capacity and experience *

(e.g. participation in academic governance or serving as a department chair, faculty development director, or other administrator.)

Describe relevant areas of expertise *

(e.g., knowledge of the assessment literature, the teaching and learning literature, national issues and controversies in higher education, statistics, research design, institutional research).

Describe your participation in relevant educational opportunities *

(e.g., ARC workshops, WASC assessment retreats, or other assessment conferences.)

What types of institutional support will the campus provide for your participation *

	Partial Support	Full Support	No Support
Registration fee	Partial Support	Full Support	No Support
Travel expenses	Partial Support	Full Support	No Support
Purchase of required readings	Partial Support	Full Support	No Support
Release or reassigned time	Partial Support	Full Support	No Support

Acknowledgement of campus support and intentions for engaging the applicant *

(Click browse and identify the file you wish to upload with your application) Please attach a letter(.pdf or .doc) acknowledging campus support and intentions for engaging you in an on-going assessment leadership role. The letter should be from an administrator at the level of Dean, Division Lead/Director, Chief Academic Officer or higher.

Name of nominating administrator *

Title of nominating administrator *

Email of nominating administrator *

Signature of the applicant *

Please reenter your email address as an electronic signature confirming your application.

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Application for the Assessment Leadership Academy