Fillable Congratulations on your decision to pursue the St. (State University of New York College at Potsdam)

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Congratulations on your decision to pursue the St. (State University of New York College at Potsdam)

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  • 26 check-boxes
  • 36 other fields

Country of origin: US
File type: PDF

U.S.A. forms for State University of New York College at Potsdam

BROWSE STATE UNIVERSITY OF NEW YORK COLLEGE AT POTSDAM FORMS

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Application Checklist
Phase I
Submit the below documents to: slli@potsdam.edu
Application (copy attached)
Updated Resume
Phase II
Once received ALL applicants will be contacted by a steering committee member to
schedule a brief conversation.
Steering Committee Conversation
Phase III
Upon review of credentials and approval by the steering committee to advance to the
next phase, selected applicants will receive an invitation to submit essays that addresses
both of the following:
Leadership Reflection (1-3 pages):
Provide an overview of your leadership journey. What has been your experiences in
positions of influence and change, and how do you draw upon those experiences in your
professional life? What you consider to be some of your greatest strengths as a leader,
and what are some of the ways you would like to improve upon your leadership abilities?
St. Lawrence County - Reflection (1-3 pages):
In your opinion, what is the most important challenge facing your local community or St.
Lawrence County now and in the next 5 years? What do you think an effective
community leader should do about it?
Congratulations on your decision to pursue the St. Lawrence County Leadership Institute! This
is a great first step towards your commitment to your personal and professional growth, as well as your
commitment to understanding and advocating for St. Lawrence County. The application process is
confidential; only the admissions committee will review and discuss your application with you. The
application process is comprised of 3 phases. You can follow along your process utilizing the
checklist below.
Applicants will be reviewed on a rolling basis, and enrollment is open until the class is full, or, the
program commences. Application materials may be forwarded to slli@potsdam.edu. Questions can also
be directed to 315-267-2165.
❑
SLLI alumnus/na
❑ newspaper
❑ SLLI board member
❑ radio
❑ chamber newsletter
❑ other: (please specify)____________________________
– 1 –
❑ Female
❑ Asian
❑ Black or African American
❑ Native Hawaiian or other Pacific Islander
❑
White
❑ Other
❑ Choose not to disclose
PERSONAL DATA
Name______________________________________________________________________________________________________
_
Address ____________________________________________________________________________________________________
City, State, Zip _______________________________________________________________________________________________
Phone Numbers
_____________________________________ (home) ____________________________________________ (work)
Preferred E-mail ______________________________________________________________________________________________
Total years living/working in St. Lawrence County: _____ How did you learn about St. Lawrence Leadership Institute?
Are special accommodations necessary? If so, please describe (This response does not affect one’s candidacy. It is intended to help
SLLI to comply with the Americans with Disabilities Act.):
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
PERSONAL BACKGROUND – Optional. This information is completely confidential and voluntary and will be strictly
used for aggregate class profile/demographic information.
Gender
Ethnicity
Race
❑ Male
Are you Hispanic/Latino?
❑ American Indian or Alaska Native
❑ Yes
❑ No
If Yes, please select one of the following:
❑ Central American
❑ Dominican
❑ Mexican
❑ Puerto Rican
❑ South American
❑ Other Hispanic/Latino
EDUCATION: Include any special training courses or certificates:
Dates (from/to)
School
Location
Degree/Major/Type of Study
• ______________________________________________________________________________________________________
• ______________________________________________________________________________________________________
• ______________________________________________________________________________________________________
– 2 –
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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Completed 27 August 2020

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