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Seminar Application Form

Seminar Application Form

National Rehabilitation Leadership Institute

 

Application for Executive Leadership Seminar Series


 

* An asterisk = required fields

  


  

General Information:










 

* Prior Leadership Training

In the space provided below, please list all leadership courses and/or training programs that you have completed in the past 3 years. Include the title of the training program, where the program was offered, its duration, and whether or not a certificate was awarded for participation.

 

Applicants are required to submit a one-page typed essay with their application, describing their experience in the field to date and stating why they wish to participate in the Executive Leadership Seminar. Briefly describe your present responsibilities. Describe a specific experience that you feel clearly highlights your skills and abilities as a leader.

Please identify the three or four of the most significant leadership issues that you want to examine during the seminar series. We will use these issues to shape selected aspects of the Seminar content and ensure the relevancy of the Seminar Series to your expectations.

Statement of Agreement (must match with name provided above)

By entering your name, you agree to attend all of the following conditions:

  1. I will attend all sessions of the Executive Leadership Seminar series.
  2. I will actively participate in all exercises, team projects, and peer discussions.
  3. I will participate in the Executive Coaching portion of the Seminar Series.
  4. I have access to and feel comfortable using virtual media, such as email and the internet.
  5. My organization will cover the costs for the Seminar Series.
  6. My supervisor/Director supports my application.