Important: Fill-out this questionnaire within 1-7 days from receiving it.
As we have informed you, there will be following residential sessions during the Academy: 1. The main residential session at the Pałac Mała Wieś on September 19th (check-in: 12:00 pm - 2:00 pm) through September 25th (end: 6:00 pm); 2. Second Residential Session: October 21-22 (from 8:00 am to 8:00 pm) 3. Third Residential Session: December 9-10 (from 8:00 am to 8:00 pm)
While applying to the Academy you have read and accepted the Rules for Fellowships (see here), so here we just summarize the main points.
Benefits of Fellowships:
You have been granted a Full Fellowship with access to the Academy’s whole educational experience (read). In addition the Academy covers about PLN 2000 per fellow of your accommodation expenses at the campus during the main residential part, including part of the room cost, all breakfasts, all lunches, coffee and snack breaks as well as welcome and farewell dinner.
In summary the Rules for Fellowships are the following:
The requirement for you to participate in the whole program of the Academy is the registration contribution of EUR 350 (PLN 1575) paid by wire transfer not later than 7 days from receiving this form. Registration contribution serves three important functions. Firstly, it is a sign of commitment – we want fellows to be committed to the Academy’s work and be fully present during the program. We want to avoid situations in which candidates accepted to the program do not show up for classes, because “they are for free”. This is a real loss because it deprives other talented people of having the opportunity to participate in the Academy. Secondly, part of the commitment contribution will cover some marginal costs of the Academy. Thirdly, it is a way of helping the Academy grow and ensuring her sustainability in the future so we can provide fellowships for other talented people in the coming years – fellows for fellows by fellows.
The transfer of the registration contribution must be made on the following account: - receiver's name: Center for Leadership - account no.: 16 1140 2004 0000 3802 7425 6416 - subject: “Opłata rejestracyjna Leadership Academy for Poland”.
After the program we will ask you, as alumni of the Academy, for a donation to support future editions of the Academy and the LAP Alumni Network - in accordance with the Rules for Fellowship. We very much hope that as alumni of the Academy you will be active members of the LAP Alumni Network and help us develop the program further and make it better and accessible to other talented Poles.
Before the first residential part we will give you access to a personalized class website which will include all important information related to the course work as well as short bios of all fellows of the Class which will give you a chance to get to know each other before arriving at the campus. Therefore we would like to ask you to fill out the fields below.
We are planning to make photo and video recaps of the Academy, which will include some photos from the sessions as well as some interviews with the fellows. We will use them to create memory gifts to all fellows as well as to create media material for the preparation of the next edition of the Academy. Some of the materials may appear in the public media, including print, internet, and/or broadcast media.
To ensure safety, the session will take place with necessary sanitary restrictions - where needed with appropriate testing, and all rooms will be prepared for you as single rooms. If any of you will have any health concerns, please let us know directly.
Follow temporary limitations and recommendations introduced by the Polish Government here.
On the Online Patient Account you can find your vaccination certificate and download a QR code that confirms that you are vaccinated. Please have it with you at the session.
The Academy covers about PLN 2000 per fellow of your accommodation expenses at the campus during the main residential part, including part of the room cost, all breakfasts, all lunches, coffee and snack breaks as well as welcome and farewell dinner.
Each fellow covers the rest of the room cost in the amount of PLN 270 per night for the single-room option (we cover the remaining of the regular price).
In order to make a booking, please contact the Pałac Mała Wieś reception at recepcja@palacmalawies.pl or +48 782 40 40 40, stating that you are a member of the Leadership Academy for Poland Class of 2021 and specify the type of the room you are interested in (single).
As previously mentioned fellowships cover welcome and farewell dinner at the campus. Please let us know if you have any special dietary requirements. Please be mindful: Your choice will be applied at all residential sessions of the program.
General Release Form and Assumption of Risks
I have chosen voluntarily to enroll in the Leadership Academy for Poland - LAP (understood to include all activities at destinations, and all travel to and from such destinations.). This agreement confirms my understanding of the following:
1. Risks of Participation and Travel. I understand that participation in the LAP include risks inherent to this event, including but not limited to transportation to, from, and around the LAP destination, accidents, illnesses, any risks associated with independent activities I undertake as an adjunct to the LAP, all of which could include injuries or property damage or loss. I further understand that the Center for Leadership cannot and does not assume responsibility for such events or personal injuries or property damage arising there from LAP. I have made my own investigation of these risks, understand these risks and assume them knowingly and willingly.
2. Health and Safety Concerns. I am aware of my own personal medical needs and hereby warrant that there are no health-related reasons or problems that preclude or restrict my ability to participate safely in the LAP. I assume all risk and responsibility for my medical needs, and understand and agree that if I must be hospitalized or otherwise receive medical care, the Center for Leadership cannot and does not assume legal responsibility for payment of such costs. I hereby warrant that I have adequate health insurance coverage to meet any and all needs for payment of medical costs while undertaking the LAP.
3. COVID-19. I am aware that the virus is thought to spread mainly from person-to-person, between people who are in close contact with one another (within about 2 m), through respiratory droplets produced when an infected person coughs, sneezes or talks. Some recent studies have suggested that COVID-19 may be spread by people who are not showing symptoms. Taking care of all participants and myself I will follow all the sanitary restrictions advised by the government and the LAP and monitor my health daily informing the LAP immediately if symptoms develop.
4. Standards of Conduct. I recognize that I assume an important personal obligation to conduct myself in a manner compatible with local laws and regulations of the Pałac Mała Wieś. I also assume all responsibility for any damage or injury I may cause during the LAP by doing or wrongdoing. I understand that if I do not behave in accordance with policy and law, I may be asked to leave the LAP and will be responsible for all personal expense thereafter, including return transportation.
5. I have read and fully understand the Pałac Mała Wieś rules of stay (read here).