“UB-a-Leader” Leadership Certificate Program
Application and Contract

Name    Date 

Major      Sport        GPA 

E-Mail 

Have you ever taken the DiSC assessment?  yes  or   no

 

Please list and explain, if necessary, any community service completed during your collegiate career:





Please list and explain, if necessary, any leadership training, development and/or education you have completed during your collegiate career:

 

How did you learn about the Leadership Certificate Program?





In 500 words or less, please attach a statement of goals, expectations, and purpose for participating in this leadership program.  Please be sure to use proper spelling and grammar.







 Contract


Student- Athlete: Please review the contract and initial where necessary


Training:

 
    Attend and participate in 4 Life Skills development workshops available though the Office of Student-Athlete Affairs , or another on or off campus activity with supportive documentation.
 

    After each workshop, complete the “Leadership Workshop Reflection Form”


Education:


   Complete UBE102 with UBE110 being optional
 

   Attend and participate in 6 Leader Links meetings



Development:

 

    Initiate, participate, and complete 2 community service projects involving at least 5 student-athletes or students.  Each project will be approved by the Leadership Advisor with the direction of creating positive change. 

 
   Complete a total of 20 hours of community service hours over the life of the program.
 

   Attend and participate in at least 2 Student-Athlete Advisory Committee (SAAC) meetings per semester.  Attendance at a different committee’s meeting will be permitted if the student-athlete’s class schedule conflicts with SAAC meetings. 

 

Activity Transcript:

   After completing any of the requirements, update the Activity Transcript provided by the University at Buffalo.

 

Program Timeline

 

    This program’s lifespan is 2 academic years, therefore, at the conclusion of the first academic year 2 workshops, 3 Leader Links meetings, 1 community service project, 10 hours of community service, and attendance at 2 SAAC meetings will be completed.  Immediate removal from program will take place if these requirements are not met by the end of the first year with the exception of extenuating circumstances.  Any requirements not completed 1 month prior to the end of the first academic year will be brought to the attention of the student-athlete.  Please note that this program’s timeline is subject to change and you will be notified with any changes.

 

Final Reflection:

 

   Upon completion of requirements stated above, the “Final Reflection” form  will be completed, which includes, but not limited to, your experience in the leadership program, changes in your leadership style, and support on why you have chosen your leadership style.   

 
 

Disclaimer:

 Please note that exceptions can be made in order to “grandfather” in upper-class student-athletes who have been actively involved and have already met some of the requirements.

 
Leadership training, education, and development completed prior to program participation will be reviewed to determine if these experiences may  be utilized in fulfilling this program’s requirements.


!,  , have carefully reviewed the “UB-a-Leader” Leadership Certificate Program Contract and understand the conditions for participation in the “UB-a-Leader” Leadership Certificate Program. 



Student-Athlete Electronic Signature  

Student-Athlete Sport          Date