1 | 2017 Green Industry Leadership Institute Application
2017MNLA Green Industry Leadership Institute Application
(To be completed by program candidate and employer. Attach additional sheets as needed.)
Personal Information
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FirstMiddleLast
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Home Address
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CityStateZip
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EmailBusiness PhoneCell or Home Phone
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Company Name
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Business Address
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CityStateZip
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Date Your Employment BeganJob Title
Employer/Sponsor Information
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Sponsor Name and Role at Company
(This person will monitor the candidate’s progress during the Green Industry Leadership Institute.)
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Business Address
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CityStateZip
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EmailPhoneCell
Work History
List your three most recent positions and length of time that you served.
Leadership Training
Describe below any previous leadership training or related education, and when the training occurred.
Personal Learning Goals
What specific skills or knowledge do you hope to gain from participating in this Leadership Institute?
Outcome Desired
What career goal do you hope to attain by attending the Green Industry Leadership Institute?(i.e. move to a different position, add more responsibility for project management, be a part of a leadership team, be asked to participate in a strategic planning exercise, mentor and coach someone else, lead a crew, present at an MNLA event, be able to tackle a specific project on behalf of the company, meet other green industry leaders, etc.).
Applicant Agreement
If selected for the MNLA Green Industry Leadership Institute, I fully understand the tuition requirements andthe expectation of attendingall scheduled sessions, and reporting progress each month with my sponsor. I am a current employee with an MNLA member, and will continue to be an employee in good standing at my current company for the duration of the program.
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Applicant’s SignatureDate
Sponsor Agreement
I fully understand the tuition requirements and the expectation that if selected the applicantwill attend all scheduled sessions for the MNLA Green Industry Leadership Institute and give monthly reports to their supervisoron their progress in the Institute. Should the applicant transition to another company during the year, I understand that the program fee will not be refunded.
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Sponsor’s SignatureDate
Additional Submissions
Letter of Recommendation
Each application must include a letter from the sponsoring company describing why the applicant has the potential to be a business leader in the green industry and how his/her participation could benefit their company and the green industry. Please include your analysis of their leadership goals.
Payment Information
The program fee is $1,300. No application will qualify without accompanying payment. Should the applicant not be selected for this year’s class, the full amount will be refunded. For those applicants selected for the program, the program fee is nonrefundable.
☐ Check Enclosed ☐ Visa ☐MasterCard ☐ Discover | ☐ Billing address is same as company address. ☐ Billing address is:
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Card holder name: ______Card No. ______- ______- ______- ______Exp.: _____/_____
Please send completed application via mail (MNLA, 1813 Lexington Ave. N, Roseville, MN 55113),
email (), or fax (651-633-4986).