Upload
others
View
1
Download
0
Embed Size (px)
Citation preview
PLEASE TYPE OR PRINT
DESCRIPTION OF YOUR PRESENT
RESPONSIBILITIES
BRIEF DESCRIPTION OF YOUR ORGANIZATION
number of employees, annual operating budget, function
or service provided, etc.
PREVIOUS EMPLOYMENT HISTORY
in reverse chronological order
Mr. Ms.
Last Name First Name MI
Preferred Name Date of Birth
Title Organization
O�ce Address
City State Zip
O�ce Phone Cell Phone Fax
Email Years in Current Position
Name of Organization Title/Position Dates: From–To
----- -----
----- -----
----- -----
----- -----
You may download a printable version of this form from our website: http://sei.coopercenter.org/
2018
LEAD/ SEI Application
LEAD Dates SEI Date
July 15, 2018
Applications for SEI are due June 1st
Select program preference
EDUCATIONinclude intensive management
development programs
WHY DO YOU WANT TO PARTICIPATE IN
LEAD / SEI?
MYERS BRIGGS
ACCOMMODATIONS
POLO SHIRT SIZE
SIGNATURE OF APPLICANT
FEES
DISCOUNTS
REFUNDS & CANCELLATIONS
DEADLINES
EMAIL TO
Institution Degree/Program Dates: From–To
Are you familiar with the Myers Briggs Type Indicator? No Yes Type _____________
All rooms are non-smoking
Small Medium Large X-Large XX-Large
Signature of Applicant Date
Special e�ort is made to keep LEAD/SEI reasonably priced. The fee below include the cost of instruction,all materials, most meals, and housinag. Unless prior arrangements have been made, fees are due one month before the start of the program.
A 10% discount is granted to any participant from a Virginia locality that is a member of the Virginia Institute of Government. Virginia Institute of Government Member; Yes No
A 50% fee will be assessed for cancellations within two weeks of the beginning of the program. Substitutions, acceptable to LEAD/SEI, may be made up to two weeks before the start of the program.
Please tell us how you heard about LEAD / SEI.
Name Title
Locality
Other
Payment is due 1 month before the start of program.
Molly HarlowSEI Program [email protected]
Carmie Rodriguez, LEAD Program [email protected]
P.O. Box 400206 • Charlottesville, VA 22904-4206434/987-0331 • Fax: 434/982-5524 • TDD: 434/982-HEAR
LEAD fees are $4,450. SEI fees are $8,100.
SEI application due June 1st. LEAD application due 8 weeks prior to the program.