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REFERENCES – Please list two individuals who are familiar with your leadership potential or abilities. You will be responsible for
asking your recommender's to email a letter of support to slli@potsdam.edu (may also be mailed using address below).
Name ________________________________________________
Company/Organization __________________________________
Telephone ____________________________________________
Email ________________________________________________
❑ I wish to apply for a payment plan (optional): Someone will follow up with you.
Candidate: I hereby apply to be a participant in the St. Lawrence Leadership Institute. I have carefully read the attached brochure that
explains the mission and goals of the Institute, and its policies regarding selection criteria, selection process, time commitment, and tuition
(including the financial liability schedule). I further state that I am responsible for the balance of any tuition not provided by my financial
sponsor, if any. Furthermore, I understand that should I fail to meet these responsibilities, I will be asked to withdraw from the program.
Candidate’s Signature ________________________________________________________________ Date __________________________
Financial Sponsor: I agree to pay the amount of $_________
towards the $600 tuition for the above applicant if he/she is accepted.
Financial Sponsor’s Name and Title (please print clearly): ____________________________________________________________
Signature of Authorized Individual ______________________________________________________________Date ___________________
Mailing Address ___________________________________________________________________________________________________
Phone Number _____________________________________________E-mail __________________________________________________
Employer: I agree to provide the above-mentioned employee the time required to be an active member of the St. Lawrence Leadership
Institute for this year’s class.
Employer’s Name and Title (please print clearly): ___________________________________________________________________
Signature of Authorized Individual ______________________________________________________ Date _________________________
Phone Number ______________________________________________ E-mail ________________________________________________
IMPORTANT NOTES
Applications must be postmarked by the appropriate deadline to be considered for admission. Each
applicant will be notified of the Admission Committee’s decision within three weeks of the deadline
dates. Class size is limited to 25.
Early Admission Deadline:
Space Permitting Deadline:
June 1
August 1
Send completed application to St. Lawrence Leadership Institute at SUNY Potsdam to:
St. Lawrence Leadership Institute at SUNY Potsdam
Attn: Admissions Committee
44 Pierrepont Ave.
Raymond Hall 206
Potsdam, NY 13676
Questions?
Contact the SLLI steering committee by emailing
slli@potsdam.edu or by phone at
315-267-2165
Name ________________________________________________
Company/Organization __________________________________
Telephone ____________________________________________
Email ________________________________________________
❑ I wish to get information about scholarship funding: Someone will follow up with you.
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