Broome Leadership Institute Application


Application Form for BLI
APPLICATION - PART ONE
Home Address
Business or Organization Affiliation (if any)
US Citizen *
Send BLI Mail to: *
Shirt Size *
Maximum participation is vital to the success of Broome Leadership Institute. If you are selected, are you and (if applicable) your employer willing to commit to your participation in the mandatory orientation retreat and attendance at 75% or more of all sessions. Tentative dates are: 9/20/19 (retreat), 10/3, 10/17, 10/31, 11/7, 11/21, 12/5, 12/19, 1/16/20, 2/6, 2/20 3/5, 3/19, 3/26 (graduation) I can attend the retreat and at least 75% of the sessions *
IF ACCEPTED AS A BROOME LEADERSHIP INSTITUTE PARTICIPANT, I UNDERSTAND THAT I AM COMMITTING MYSELF TO INVOLVEMENT IN THE COMMUNITY UPON GRADUATION FROM THE PROGRAM, AND THAT MY NAME, CONTACT INFORMATION AND PHOTO WILL BE INCLUDED IN THE BLI YEARBOOK/DIRECTORY LOCATED ON THE CHAMBER'S WEBSITE. *
The signature of your supervisor (if employed), as an indication of support, is required. Use the document at http://gbeop.org/broome-leadership-institute-pg.html. You may either upload here, email the form to dbritton@greaterbinghamtonchamber.com, or fax to (607) 722-4513.
Application - Part 2
Please answer the following questions in short-answer form. Do not substitute a resume for this application; however, you may attach a resume as additional information if you wish.
Please list: Name and city of college, community college and high school attended. Please include major and degree received, where relevant. Also add business or trade school and other specialized training. Additionally, please include extracurricular activities, special honors or awards for leadership activities and special recognition for academic achievement.
Please list the important points in your employment history beginning with your present position. What do you consider your highest responsibility, skill or career achievement so far? Any other relevant experience?
Please list the major civic, business and professional activities you have participated in during the past five years. What do you consider your highest responsibility, skill or voluntary achievement so far? If you have not been involved in such activities, or if you would like to expand your involvement in other areas, please describe the areas in which you would like to become involved, and why. How much time, each month, do you or would you commit to community, civic, professional and other organizations and activities?
What do you consider to be your best skills? (Examples: planning, organizing, communicating, etc.) How do these skills contribute to your leadership role(s) or occupational activities? What organization(s) have you belonged to, or experience(s) have you had, that have contributed significantly to your personal development? Please explain.
If you would also like to submit a resume, please include it in this upload. This is not a requirement.
References
Use the documents at http://gbeop.org/broome-leadership-institute-pg.html to send to each reference. You may either upload each reference here, have your references email the form to dbritton@greaterbinghamtonchamber.com, or fax to (607) 722-4513.
Reference #1
Reference #2
Reference #3
If you are applying for the scholarship, please use the document at http://gbeop.org/broome-leadership-institute-pg.html. You may either upload here, email the form to dbritton@greaterbinghamtonchamber.com, or fax to (607) 722-4513.