NRLI - The National Rehabilitation Leadership Institute

Application Form for the Executive Leadership Seminar

Cohort 8: Session 1 -- May 2 - 6, 2011
San Diego State University

Application Procedure

The National Rehabilitation Leadership Institute (NRLI) accepts both electronic and paper applications for those seeking admissions to the Executive Leadership Seminar Series.

Application Deadline: February 15, 2011

Please read the following information carefully to determine the materials needed for application.

Click here for Paper Application

Click here for Electronic version

Applicants may complete the paper application as part of this package. The paper version requires submission of the application with all supporting materials in a self-assembled packet. The appropriate forms should be submitted, with all required documents, by the published
deadline date.

Essay

A one page typed essay is required, describing your experience in the field to date and stating why you wish to pursue the Seminar. A series of questions that should guide your response are included on the application form.

Letters of Recommendation

Three letters of recommendation are required, and should address the candidate's leadership and administrative abilities. A letter of recommendation must be submitted from each of the following sources:

1.   the State VR Director (or his or her designee)

2.   the applicant's supervisor; and

3.   a current colleague

Current Resume/Vita

Applicants should include an updated copy of their vita with the application. The vita should include prior and current work and educational experiences.

You may include a paper copy of your vita if you submit a paper application packet, or you may attach your vita and send via E-mail to:

sdavis@interwork.sdsu.edu

Admission and Program Fee

Review of your application will begin once all required materials are received and an application is considered complete. Applicants will receive written notification of their status as soon as possible. Individuals accepted into the Executive Leadership Seminar Series will be sent detailed instructions regarding how to pay and register. The fee for each of the four sessions is $750.00, payable at least ten days before each session.

Accommodations

If you require any accommodations to ensure your full participation in any activity sponsored by the NRLI, please provide the necessary information to the NRLI at least 20 days prior to the activity so that appropriate arrangements may be made.

Questions

If you have any questions regarding the application form, the admissions process, or application deadlines, please contact the NRLI at:

National Rehabilitation Leadership Institute
Interwork Institute
San Diego State University
3590 Camino Del Rio North
San Diego, CA 92108
Phone: 619-594-4220
Fax: 619-594-4208
E-mail: sdavis@interwork.sdsu.edu

Electronic Application for Executive Leadership Seminar Series

* - required fields

CRC Credits requested

General Information:

* Full Name (Last, First, Middle Initial):

* Current Position Title:

* Organization:

Work Address (Street, City, State, Zip):

Home Address (Street, City, State, Zip):

* Work Phone (valid format is xxx-xxx-xxxx):

Home Phone (valid format is xxx-xxx-xxxx):

* E-mail:

Fax (valid format is xxx-xxx-xxxx):

* 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.

* Essay

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.

Statement of Agreement (must match with name provided above)
By entering your name, you agree to attend all of the following conditions:

I will attend all sessions of the Executive Leadership Seminar series.
I will actively participate in all exercises, team projects, and peer discussions.
I will participate in the Executive Coaching portion of the Seminar Series.
I have access to and feel comfortable using virtual media, such as email and the internet.

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Please email and questions or suggestions to mike@interwork.sdsu.edu