Fillable 2020 21 NC EPFP Central Application Updated

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2020 21 NC EPFP Central Application Updated

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Return This Completed Application Along With Your Signed Agreement to:
Public School Forum of North Carolina
Attn: Lauren Bock
EPFP@ncforum.org
Deadlines: We will be reviewing applica
tions and will provide
rolling acceptances on March 31, April 30, May 15, June 1,
June 15, June 30, July 15, and
July 31 (final deadline).
1
2020-21 Education Policy Fellowship Program Application
General
Name (first, middle, last): _________________________________________________________
Professional Title: _______________________________________________________________
Organization/Institution: _________________________________________________________
Division/Dept. (if applicable): ______________________________________________________
Work Address:
______________________________________________________________________________
______________________________________________________________________________
Office Phone: (______) ______________________ext_________
E-mail Address: _________________________________________
Home Address (street, city, state, zip):
______________________________________________________________________________
______________________________________________________________________________
Cell Phone: (_______) _________________________________
Race/Ethnicity & Gender: (Required by IEL for demographic tracking only)
______________________________________________________________________________
Birthday Month & Day ___________________________________________________________
Food Allergies or Dietary Restrictions _______________________________________________
How did you learn about EPFP?
______________________________________________________________________________
______________________________________________________________________________
2
Education
Please list most recent institution first.
University/College State Major Degree Year
EPFP Outcomes
Please provide narrative responses of one page or less to each of the following questions, which
relate to the personal and professional benefits of EPFP.
1) What are your career goals and/or professional growth goals, and how will participating
in EPFP support you in meeting those goals?
2) How would your participation in EPFP benefit your organization? Please discuss this
question with your sponsor and be as specific as possible about the value you hope your
participation in the program will add, or how your development through the program
will help you contribute to organizational priorities.
EPFP Program Components
NC EPFP is an immersive professional and leadership development experience. Below is a
tentative schedule for 2020-21:
Fellows will participate in a variety of program sessions over the course of the year, beginning
with a two day Fall Retreat on the history and context for public education in North Carolina on
October 5-6, 2020 in Raleigh and a Winter Retreat on December 3-4, 2020 in Blowing Rock, NC.
Fellows will attend a Fall Meeting on November 9, 2020 and two weekday policy sessions in
the winter, scheduled for January 25, 2021 and February 22, 2021 in Raleigh.
In the spring, Fellows will attend the annual Washington Policy Seminar in Washington, DC on
March 21-24, 2021, which brings together Fellows from EPFP programs across the country.
Finally, the year’s capstone event will be the Spring Retreat which includes the annual EPFP
Legislative Day and Graduation scheduled for April 26-27, 2021 in Raleigh.
3
Endorsement: To the Supervisor/Employing Agency Representative
Fellows are required to attend all program components listed above, including weekday
sessions, retreats, the Washington Policy Seminar in March, and the Legislative Day and
Graduation event in April. Tuition and all travel-related costs are paid by the sponsoring
organization. Your signature ensures (1) your employee's release time for full participation in
the program and (2) payment of program-related costs, including tuition and travel. If you
have questions, please contact Lauren Bock, Director of Policy & Programs at the Public School
Forum of NC, at 919-781-6833 or EPFP@ncforum.org.
Name of Applicant: ______________________________________________________________
Applicant's Signature: ____________________________________________________________
Supervisor/Sponsor's Name: ______________________________________________________
Supervisor/Sponsor's Signature: ___________________________________________________
Supervisor's Title: _______________________________________________________________
Supervisor's Organization/Institution: _______________________________________________
Supervisor's Division/Dept: _______________________________________________________
Supervisor's Office Address:
______________________________________________________________________________
______________________________________________________________________________
Supervisor's Office Phone: ________________________________________________________
Supervisor's E-mail Address: ______________________________________________________
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Return This Signed Agreement Along With Your Completed Application to:
Public School Forum of North Carolina
Attn: Lauren Bock
EPFP@ncforum.org
AGREEMENT OF UNDERSTANDING
FOR PARTICIPATION IN THE
2020-2021 NORTH CAROLINA EDUCATION POLICY FELLOWSHIP PROGRAM (EPFP)
EPFP is an immersive professional and leadership development experience. With the
understanding that the maximum benefits are achieved through full participation by the EPFP
Fellow in all retreats, virtual meetings, the national conference in the spring, and the
legislative day/graduation event, the undersigned EPFP Fellow and EPFP Fellow's supervisor
hereby agree that the Fellow will participate in all meetings, retreats, the national conference,
and the legislative day/graduation event. The supervisor will be notified if the EPFP Fellow
misses more than 1.5 days of EPFP programming which is the allowable amount of excused
absence for the year.
At the fall, winter, and spring retreats, Fellows will be expected to be fully present and may be
unable to access email for extended periods. Therefore, the supervisor and Fellow should plan in
advance to avoid pressing assignments that require Fellows to be accessible on the retreat
dates.
The EPFP Fellow and EPFP Fellow's supervisor understand that these conditions are requisites
for the EPFP Fellow to receive a certificate of completion of the program and access to networks
and resources available to EPFP alumni.
______________________________________________________________________________
EPFP Fellow's Name Fellow's Signature Date
______________________________________________________________________________
Sponsor's Name Sponsor's Signature Date
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2020 21 NC EPFP Central Application Updated

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Completed 18 July 2020

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