Seminar Application Form

Seminar Application Form

National Rehabilitation Leadership Institute


Application for Executive Leadership Seminar in Rehabilitation Administration

* An asterisk = required fields



General Information:


* Prior Leadership Training

In the space provided below, please list the 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 a certificate or academic credit 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 in Rehabilitation Administration. 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 of the most significant leadership issues that you want to examine during the Seminar. We will use these issues to shape selected aspects of the Seminar content and ensure the relevancy of the Seminar learning experiences to your expectations.

Statement of Agreement (must match with name provided above)

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

  1. I will attend all sessions of the Executive Leadership Seminar in Rehabilitation Administration.
  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.
  4. I have access to and feel comfortable using virtual media, teleconferencing, video platforms, email and the internet.
  5. My organization will cover the costs for the Executive Leadership Seminar in Rehabilitation Administration.
  6. My supervisor/Director supports my application.