2014-2015NRLI APPLICATION

The application deadline for NRLI Class XIV isJuly 1, 2014,but we encourage you to apply now if you wish to attend. The project team will periodically review applications and notify applicants of their status.

Please return this application form as an e-mail attachment or fax to:
Attention:Jonathan Dain
E-mail: jdain@.ufl.edu

Fax: 352-846-0458 Tel: (352) 294-7697
Your application can also be mailed to:

1193 McCarty Hall A, University of Florida, PO Box 110240, Gainesville, FL, 32611-0240
[Please type or print]

1. Full Name:

Address:

Phone Number: Cell Phone Number:

Preferred E-mail Address:

2. Current Employment
a) Employer’s Name:
Tel:
E-mail:
Fax:
Employer Address [Street or Box No]:
City:
State:
Zip:

b) Your Position Title:
c) Total Number of years in your present occupation:
Full-time:
Part-time:

d) Present Responsibilities:

3.Why are you interested in being a NRLI Fellow and what specificallywould you hope to learn through the program?

4. How do you (and if relevant, your supervisor) think that your participation in NRLI could contribute to your future career and/or organizational goals?

5. What do you consider to be your most meaningful contribution to your community, organization, or profession?

6. From your perspective, what are the most important natural resource-related issues in Florida today? If you were to complete the NRLI Program (see question 3) what could you do to help address these issues?

7. List two business and/or personal references:

  1. Name:
    Tel:
    E-mail:
    Fax:
    Address [Street or Box No]:
    City:
    State:
    Zip:
  1. Name:
    Tel:
    E-mail:
    Fax:
    Address [Street or Box No]:
    City:
    State:
    Zip:

8.Who will pay your registration fee? [Indicate with a number: ]

1. Employer2. Yourself 3. Other

  1. How did you hear about the Florida NRLI program?

There is no application fee.

If accepted for NRLI Class XIV and planning to attend, arrangements for payment of the registration fee of $4100 should be made by August 1, 2014. The $4100 fee covers all instruction, lodging, meals, and field trips. Transportation to and from each session is the responsibility of each Fellow.

I understand the goal of the Florida Natural Resources Leadership Institute. I understand that participation in all Institute activities is mandatory and I am willing to devote the time to participate in this program as described in the application. If my fees are paid by my employer, I affirm that I have conferred with my supervisor and that he/she understands that my involvement in FNRLI will demand all of my time and attention during the NRLI's scheduled sessions.

______

Applicant’s Signature(an electronic signature is acceptable at this time)

Date: ______

Applications can be scanned to or faxed to 352-846-0458

With a cover sheet that says TO THE ATTENTION OF NRLI

Your application can also be mailed to: 1193 McCarty Hall A, University of Florida,

PO Box 110240, Gainesville, FL, 32611-0240

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