Advanced Agricultural Leadership Program Supported and Offered by Rural Ontario Institute
Advanced Agricultural Leadership Program Advanced Agricultural Leadership Program   Friday, September 10, 2010  
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Application Form Class 13 (2009-2011)

Important Note for Online Registrants:

When submitting an order/registration online, you will receive the following message, along with a complete review of your personal information and order/registration, after pressing Submit Online.

This confirms that your order/registration has been submitted properly and received by AALP. If you do not receive this message your order/registration has not been submitted properly. Review the form as some fields may have been skipped or filled with an invalid format. Please telephone (519-826-4204) or email (info@ruralleadership.ca) right away and we will be happy to help you.

You will receive personal confirmation from the office, within 48 hours, that your order/registration has been received. If you do not hear from us, please call or email.
1 First Name:
Middle Name:
  Last Name:
  Date of Birth: / / (e.g. mm/dd/yyyy)
   
     
2 Home Address:
  Address 1:
  Address 2:
  Town / City:
  County:
  Province:
  Country:
  Postal Code:
  Phone:
  Fax:
  Email:
     
3 Business Address:
  Same as home
  Business Name:
  Address 1:
  Address 2:
  Town / City:
  County:
  Province:
  Country:
  Postal Code:
  Phone:
  Fax:
  Email:
     
4 Do you have access to email and the internet?  
  If you do not currently have access to email and high speed internet,
please explain your plans to arrange access, if accepted into the program:
  Do you have an iPod?  
     
5 Place of Birth:
  Province:
  Country:
  Are you a Canadian Citizen?  
  If no, please state country of citizenship:  
  Do you have a valid passport?
  If no, are you eligible to obtain a passport?
     
6 Primary Occupation:
  Please check one:  
     
7 Answer only if farming is your primary occupation:
  a) Select your farming operation type (check as many as applicable):
    Dairy
Cow / Calf
Dairy Replacement
Beef
Goat
Sheep
Swine
Sow
Market Hogs
Poultry		 Poultry / Eggs
Equine
Livestock
Field Crop
Vegetable
Fruit
Organic
Cash Crop
Horticulture
Other
  If Other, please specify:  
     
  b) size, business arrangement, etc.
     
  c) Are you also working at any other occupation(s)?
  If yes, please fill out the following:
  Organization:
  Business Type:
  Position:
  Brief Description:
  Organization:
  Business Type:
  Position:
  Brief Description:
  Organization:
  Business Type:
  Position:
  Brief Description:
  Organization:
  Business Type:
  Position:
  Brief Description:
     
8 Answer only if farming is not your primary occupation:
  a) Please give employment details:
  Business / Industry Type:
  If Other, please specify:  
     
  Business Name:
  Position Held:
  Brief Description:
     
  b) Do you also produce any farm commodities?  
  If yes, please provide information (crops/livestock produced, size of operation, etc):
     
9 Past agriculture and food industry work experience:
  a) Please list and describe any past agricultural, agri-business, food industry and/or non-production experience (i.e. ag. chemicals, ag. education, food processing, distribution or marketing, ag. associations, etc.)
  Organization:  
  Dates Employed: / - / (e.g. mm/yyyy - mm/yyyy)
  Location:
  Type of Business:
  Position:
  Organization:  
  Dates Employed: / - /
  Location:
  Type of Business:
  Position:
  Organization:  
  Dates Employed: / - /
  Location:
  Type of Business:
  Position:
  Organization:  
  Dates Employed: / - /
  Location:
  Type of Business:
  Position:
     
  b) Based on the above experience, describe leadership responsibilities; and / or list innovative programs in which you've played an active role in your employment and/or business.
     
10 Formal Education:
  Name of School:
  Dates Attended: / - / (e.g. mm/yyyy - mm/yyyy)
  Date of Graduation: / (e.g. mm/yyyy)
  Degree / Diploma Completed:
  Major / Minor:
  Name of School:
  Dates Attended: / - /
  Date of Graduation: /
  Degree / Diploma Completed:
  Major / Minor:
  Name of School:
  Dates Attended: / - /
  Date of Graduation: /
  Degree / Diploma Completed:
  Major / Minor:
  Name of School:
  Dates Attended: / - /
  Date of Graduation: /
  Degree / Diploma Completed:
  Major / Minor:
     
  Other education (describe):
     
11 a) Indicate your current involvement in organizations, including agricultural, civic, church, community and government.
  Organization:
  Dates of Membership: / - / (e.g. mm/yyyy - mm/yyyy)
  Offices Held:
  Dates Offices Held: / - /
  Organization:
  Dates of Membership: / - /
  Offices Held:
  Dates Offices Held: / - /
  Organization:
  Dates of Membership: / - /
  Offices Held:
  Dates Offices Held: / - /
  Organization:
  Dates of Membership: / - /
  Offices Held:
  Dates Offices Held: / - /
     
  b) Describe your past involvement in organizations, including high school, college, agricultural, civic, church, community and government.
  Organization:
  Dates of Membership: / - / (e.g. mm/yyyy - mm/yyyy)
  Offices Held:
  Dates Offices Held: / - /
  Organization:
  Dates of Membership: / - /
  Offices Held:
  Dates Offices Held: / - /
  Organization:
  Dates of Membership: / - /
  Offices Held:
  Dates Offices Held: / - /
  Organization:
  Dates of Membership: / - /
  Offices Held:
  Dates Offices Held: / - /
     
12 Cite one specific program / project you either personally initiated, developed or played a major leadership role in completing (for one of the organizations listed in #11 a or b).
     
13 List honours and awards you have received.
  Organization or Grantor:
  Award or Honour:
  Date Received: / (e.g. mm/yyyy - mm/yyyy)
  Organization or Grantor:
  Award or Honour:
  Date Received: /
  Organization or Grantor:
  Award or Honour:
  Date Received: /
  Organization or Grantor:
  Award or Honour:
  Date Received: /
     
14 State business or pleasure reading in the past year.
  Newspapers
(read regularly):
  Magazines
(read regularly):
  Books:
  Other (ie. Online, Electronic Publications):
     
15 Do you have foreign travel experience?   Yes   No
  If yes, please describe below:
  Reason for Travel: Business   Pleasure
  Country Visited:
  Dates: / (e.g. mm/yyyy)
  Reason for Travel: Business   Pleasure
  Country Visited:
  Dates: /
  Reason for Travel: Business   Pleasure
  Country Visited:
  Dates: /
  Reason for Travel: Business   Pleasure
  Country Visited:
  Dates:  
     
16 Describe, in order of significance, what you believe to be the three most important issues facing society today. How do these relate to problems in your community and our nation?
  Issue 1:
   
  Issue 2:
   
  Issue 3:
   
     
17 What current or emerging challenges do you see facing the leaders in the agriculture and agri-food sectors and rural communities in Ontario?
     
18 What attributes should a 21st century leader have?
     
19 Why do you want to be a participant in the in Class 13 of the Advanced Agricultural Leadership Program?
     
20 How do you plan to use the knowledge and experience you will gain if you are selected for the program?
     
21 Individuals, organizations and companies within the agriculture and agri-food sectors contribute approximately 75% of the cost of this program. How do you plan to ‘give back’ to these sectors if you are selected for the AALP program?
     
22 Support from those around you is a critical factor for successful participation in AALP. Describe the kinds of personal and community networks you have established that have supported you in previous leadership roles, and how you plan to involve those people and resources to support you throughout the AALP program.
     
23 Evaluate your own potential as a leader. Please be specific.
     
24 Is there any additional information that you would like to add to this application?
     
25 25. List two references (one business and one personal) that we may contact to assess your potential for leadership within the agriculture and agri-food sectors and/or the rural community.
     
  Business Reference: Personal Reference:
  First Name: First Name:
  Last Name: Last Name:
  Business Name: Business Name:
  Position Held: Position Held:
  Address 1: Address 1:
  Address 2: Address 2:
  City / Town: City / Town:
  Province: Province:
  Country: Country:
  Postal Code: Postal Code:
  Phone: ( ) Phone: ( )
  Fax: ( ) Fax: ( )
  Email: Email:
     
     
  You will be required to download and print the following Commitment forms in PDF format. Please indicated the forms that you will be sending via mail / fax. As these forms require signature, they cannot be submitted online.
     
  Participant Commitment Form - required for all applicants Download Form Now
  Employer's Commitment Form - If you are not self-employed Download Form Now
  Business Partner's Commitment Form - If you have a business partner Download Form Now
     
  How did you hear about AALP?
  Select One:
  If Other, please specify: