1a. MANAGING FOR EXCELLENCE I: DEVELOPING THE LEADER WITHIN 18 CLASS HOURS

1b. READING & PERSONAL IMPROVEMENT PLAN PROJECT WORK 15 OUT-OF-CLASS HOURS

2a. MANAGING FOR EXCELLENCE II: POWER, INFLUENCE AND POLITICS 18 CLASS HOURS

2b. READING & PERSONAL IMPROVEMENT PLAN PROJECT WORK 15 OUT-OF-CLASS HOURS

3. MANAGING FOR EXCELLENCE III: CO-CREATING CHANGE 18 CLASS HOURS

PROGRAM APPLICATION Application Deadline: July 30, 2019

MANAGING FOR EXCELLENCE CERTIFICATIONWest Virginia Division of Personnel • OHRD

AB

OU

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NAME (FIRST/LAST)

EMAIL

LAST 4-DIGITS SSN OR EMP ID #

IMMEDIATE SUPERVISOR’S NAME/TITLE

DESCRIBE WHY YOU ARE INTERESTED IN THIS PROGRAM AND THE GAP/S OR SPECIFIC PROJECT/S YOU ARE LOOKING TO ADDRESS.(Your response will be considered along with the other eligibility requirements during the application review process, so please be thorough. You may attach additional pages if necessary)

ADDRESS

CITY STATE ZIP CODE

WORK PHONE

APPLICANT SIGNATURE

SUPERVISOR SIGNATURE

THE SUPERVISOR MUST PROVIDE (WITH THIS APPLICATION) A BRIEF MEMO NOMINATING THE APPLICANT FOR THE PROGRAM AND STATING HIS/HER AWARENESS OF THE TIME REQUIREMENTS FOR THIS PROGRAM.

PREFERRED METHOD OF COMMUNICATION PHONE EMAIL OTHER___________________________________________________________

ALTERNATE PHONE

DEPARTMENT/DIVISION/SECTION

TITLE

REQUIRED COURSEWORK (To be taken in order. You will be required to complete all of these components upon acceptance, regardless of prior attendance/completion)

August 27-29, 2019Canaan Valley Resort

DATES

March 24-26, 2020State Capitol Complex

October 20-22, 2020 Pipestem Resort

IMPORTANT, PLEASE READ:BY SIGNING THIS FORM, I ACKNOWLEDGE THAT WHILE SUCCESSFUL COMPLETION OF THIS CERTIFICATION PROGRAM MAY MAKE ME ELIGIBLE FOR CONSIDERATION FOR A DISCRETIONARY PAY INCREASE UNDER THE DIVISION OF PERSONNEL’S PAY PLAN POLICY (DOP P-12), THE DECISION TO SUBMIT THIS CERTIFICATION FOR CONSIDERATION IS AT THE DISCRETION OF THE AGENCY. ADMISSION TO, OR COMPLETION OF, THIS CERTIFICATION PROGRAM IS NOT A GUARANTEE OF A PAY INCREASE UNDER DOP P-12, NOR DOES IT CREATE AN ENTITLEMENT TO SUCH AN INCREASE.

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west virginiaDIVISION OF PERSONNEL