NORLI Class of 2012 Application

Please limit your responses to the space provided. A $35 non-refundable application fee will be billed to you upon completion of the application. This fee does not apply to tuition. As you prepare to complete the application for the New Orleans Regional Leadership Institute, please review the selection criteria.

Personal Information

Title:
First name:
Middle initial:
Last name:
Date of Birth:
Place of birth:

The New Orleans Regional Leadership Institute is committed to the selection of a class that is representative of the professional, racial, cultural and ethnic diversity of the community. Your response to the following will assist the Selection Committee in determining the class mix.

Ethnicity:
Spouse:
Number of children:
Children's names:
Hobbies:
How long living in New Orleans:

Contact Information

Address line1:
Address line2:
City:
State:

Zip:
Phone:
Home email:
Work email:
Email preference:

Employment Information

Employment description:
Months per year out of state:
Subject to transfer:
Job Title:
Work contribution:

List any business/professional affiliations in which you have been active. Do not include civic organizations or political activities.

Business/Professional Affiliations

Organization:
Position:
Dates:
Organization:

Position:
Dates:
Organization:
Position:
Dates:
Organization:
Position:
Dates:
Organization:
Position:
Dates:

Please list in order of importance to you, current community civic, religious, political, social, athletic or other activities in which you are involved and indicate your role in these activities at this time. Do not include business/professional activities.

Community Involvement

Current Community Affiliations

Organization:

Position:
Dates:

If you have had any additional community activities, past or present, that have been significant, either here or in another community, please list.

Past Community Affiliations

Organization:
Position:
Dates:
Organization:
Position:
Dates:
Most important accomplishment:

Volunteer time per month:
Would like to become more active in future:
What has changed to enable you to volunteer:

One of the goals of the New Orleans Regional Leadership Institute is to build a network of community leaders who can enhance their problem-solving and other leadership abilities through shared perspectives and working together.

Regional Perspective

Notable NOLA offerings:
Significant NOLA problems:
Hope to gain from program:
Hope to contribute to program:

General Information

Additional info for Committee:

Where did you hear about the program:

Two letters of support are to be submitted with this application which attest to the applicant's qualifications for this program and to their leadership performance and potential to create change. One letter should be from the applicant's place of employment and the other from someone you have worked with in a voluntary capacity. Please list these two references below.

References

First Reference

Name:
Title:
Organization:

Second Reference

Name:
Title:
Organization:

Letters may be sent to the New Orleans Regional Leadership Institute under separate cover and must be received no later than May 6, 2011.

Tuition
If accepted into the New Orleans Regional Leadership Institute, you will be billed for the tuition fee of $2,500, which covers all program costs and materials, including meals, as well as all the expenses associated with the retreats.
The sponsoring organization is asked to cover all of the cost. Tuition is non-refundable and is payable in full at time of acceptance unless other arrangements are made with NORLI.
To assure the diversity of the program, financial assistance based on need and class composition, is extended once selection has been made to those persons or organizations who are unable to meet the tuition requirements.
Since tuition grants are limited, each participant and sponsor will be asked to contribute some portion of the tuition. Payment plans also are available, in which tuition is paid over an extended period of time.
If you wish to request financial assistance, complete the Tuition Grant Application form. The Selection Committee will not see this form until after the selection process.
Commitment
Candidates for the NORLI must be concerned about the future of the New Orleans Region and be committed to personal involvement in shaping the future. In order to accomplish our objectives, the full commitment and participation of each individual selected is essential.
In order to accomplish our objectives, the full commitment and participation of each individual selected is essential.
Participants are expected to attend all sessions.
  • September 20 & 21, 2011 - Mandatory Retreat with overnight stay
  • Session 1 - October 19, 2011
  • Session 2 - November 16, 2011
  • Session 3 - December 14, 2011
  • Session 4 - January 18, 2012
  • Session 5 - February 15, 2012
  • Session 6 - March 21, 2012
  • Session 7 - April 18, 2012
  • Closing - May 15 & 16, 2012 - Mandatory Retreat with overnight stay
  • Graduation - June 08, 2012

Thank You for Applying
A $35 non-refundable application fee will be billed to you for processing the application. This fee does not apply to tuition.
A confirmation e-mail will be sent to you once you submit your application. If no response is received within 72 hours, please call 572-6922.

To apply online, please visit our website at

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