BLOOMBERG INNOVATION DELIVERYFELLOWSHIP APPLICATION

Please email your completed application as a Word document that includes your last name in the file name, along with your resume, y November 15, 2011.

Contact Information

First Name______

Middle Name ______

Last Name______

Email Address ______

Alternate Email (optional) ______

Mailing Address where you prefer to receive communications about the fellowship:

Street Address Line 1 ______
Street Address Line 2 ______
City______State ______Zip Code ______

Phone Number ______

Cities of Interest

The Bloomberg Innovation Delivery Fellowship requires a two-year full-time assignment to one of the cities selected for the Innovation Delivery Team initiative. Please rateeach cityon a scale of 1 – 5 according to the following statement.

I would be interested in being a member of the Innovation Delivery Team in this city:

Strongly Disagree / Disagree / Indifferent / Agree / Strongly Agree / Would you accept the fellowship award if assigned to this city? (Please check one)
Atlanta / 1 / 2 / 3 / 4 / 5 / Yes No
Chicago / 1 / 2 / 3 / 4 / 5 / Yes No
Louisville / 1 / 2 / 3 / 4 / 5 / Yes No
Memphis / 1 / 2 / 3 / 4 / 5 / Yes No
New Orleans / 1 / 2 / 3 / 4 / 5 / Yes No

References

Please use the Fellowship Reference Form to submit one reference letter and provide the following information for two additional references:

First and Last Name #1______

Organization, Title______

E-mail______

Phone Number______

Relationship to applicant______

First and Last Name #2______

Organization, Title______

E-mail______

Phone Number______

Relationship to applicant______

Short Answer Essays

Please answer the following questions in approximately 500 words each.

  1. What motivates you to pursue a career in the public sector?
  1. What makes you ready to serve as a Bloomberg Innovation Delivery Fellow?

Optional Information

Gender Male Female

How would you describe yourself?


Research Center for Leadership in Action, NYU Wagner, 295 Lafayette St, 2nd Floor, New York, NY 10012

African American/African/Black/

Caribbean American

Asian American/Asian/Pacific Islander

Latino/Hispanic

Asian/Indian

Caucasian

Biracial/Multiracial

Other: ______


Research Center for Leadership in Action, NYU Wagner, 295 Lafayette St, 2nd Floor, New York, NY 10012

______

Please email the following application materials to at yNovember 15, 2011:

  • completed application as a Word or PDF document
  • yourresume in a Word document or PDF

Please follow-up with your reference to ensure that the Fellowship Reference Form is submitted by the deadline to .

More information is available online at wagner.nyu.edu/leadership/leadership_dev/bidf

For questions or additional information, please contact us at .


Research Center for Leadership in Action, NYU Wagner, 295 Lafayette St, 2nd Floor, New York, NY 10012