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National Rehabilitation Leadership Institute

Application for Executive 
Leadership Seminar Series

Special Accommodation Request

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 an 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 three or four 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

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.

Note: Signature must be entered identically as it is at the top of this application: Full Name *