NAPALI 2018 Application

NAPALI Course EnrollmentFormApplication for 2018- PART I

Please read and follow the guidelines and instructions below. Incomplete applications will not beconsidered.This is a 5 page application form; please download, print and complete all pages.

1. Important dates to remember:

  • Application deadline is February 15, 2018
  • Tuition is due is February 15, 2018
  • Scholarship application deadline February 15, 2018
  • The course is held July 12-20, 2018

2. One (1) Passport B/W (glossy professional photograph) - head shot only - must accompanythis application.

3. A letter (if applicable) indicating your employer's commitment to release you from work toattend the eight days must be enclosed with the application.

4. Please check the appropriate statement(s):

My employer will cover the tuition fee of $3,500 if I am accepted.

A letter of commitment from my employer is enclosed.

I will be responsible for the tuition fee of $3,500 if I am accepted.

I wish to be considered for a scholarship if I am accepted. I have filled out the appropriate financial form.

  1. How did you learn about the National Pacific American Leadership Institute (NAPALI)?

I. BIOGRAPHICAL DATA (Please type your responses using the space(s) provided below)

First Name ______Last Name ______

Home Phone Number:(______) ______

Home Address:

Present Employer/Company: ______

Employer/Company Address: ______

# Years with Employer: ______

Employer is:

Nonprofit

Government

Political

Corporate

Self-Employed

Full-Time Student

Other ______

Business Phone (_____) ______Business FAX (_____) ______

E-Mail ______

Current Position: # of Years______

Supervisor's Name/Title______

Date of Birth ______Place of Birth______

Pacific Island / Native American Origin ______

NAPALI Course EnrollmentFormApplication for 2018- PART II

PLEASE NOTE: For Parts II - X, please type your reply on a different sheet of paper. Application responsesshould not exceed 12 (8½ X 11") one-sided pages;type size should be no smaller than 11point. Please include your name on the bottom right of all pages.

II. EMPLOYMENT BACKGROUND:

  1. Detail your current job responsibilities and what you have accomplished in this position. Whatspecific skills have you acquired?
  1. Briefly list your previous jobs, titles, dates of employment, and areas of responsibility.
  1. What do you consider to be your most significant professional accomplishment?

III. EDUCATION:

  1. Please list your formal educational background, including training programs and professionalinstitutes, conferences, dates attended, and highest levels completed.
  1. What obstacles, if any, have you overcome to achieve your educational goals?

IV. CAREER GOALS:

  1. Where would you like to be five years from now and what is your plan of action for achievingthese goals?
  1. Please describe your strengths, areas of improvement, and aspirations for the future.

V. COMMUNITY AND CIVIC INVOLVEMENT:

  1. List any major community, professional, religious, and/or civic activities in which you haveparticipated in the past 10 years. Indicate the specific nature and length of your involvement. Include any honors, awards, and distinctions.

VI. ISSUES ANALYSES:

  1. In a two-page essay, explain what you believe to be the major public policy issues facing Pacific American communities today.

VII. PERSONAL:

  1. Please describe your childhood and family background. How did it influence and shape who youare today as a leader, both personally and professionally.
  1. What was your most significant learning experience? Why was it so significant?

VIII. LEADERSHIP:

  1. Describe the kind of leader you are today?
  1. What kind of leader would you like to become in the future?
  1. How do you see the NAPALI program helping you to become the leader you wish to be?
  1. Why do you feel that you are the best candidate to be selected for the program?
  1. If selected for this program all candidates will be required to attend all training sessions in its entirety plus a few preliminary half-day weekend meetings or a full
  1. If selected for this programall candidates are required to attend all training sessions inits entirety. Class training sessions will be announced once selection has been completed. In addition, all selected candidates should plan on participating in a preliminary full day weekend meeting in preparation for the leadership program. Do you understand and are in agreement of with this?

Applications must be received via email to the National Pacific American Leadership Institute by February 15, 2018 for the July 12-20,2018 class. If you opt to send your application via postage mail, it must be post marked no later than February 15, 2018.

IX. REFERENCES:

Please attach a list of three references with addresses and phone numbers (excluding family members) that have knowledge of your qualifications as a professional and a Community leader.

X. CERTIFICATION:

I certify that all the information and statements in this application are true and accurate tothe best of my knowledge. I understand that the information on this application may beverified.

If selected, I will send the $3,500 tuition fee* or apply for the scholarship, on or before the February 15thdeadline toreserve my place in the July 12-20, 2018class; Moreover, I will participate fully in all required training sessions and participate in a Community or Corporate Project as part of my commitment to the National Pacific American Leadership Institute.

Print Name ______

Signature ______Date______

PLEASE EMAIL THE COMPLETED APPLICATION (as a pdf or MS Word document)TO:

------Optional Financial Information Form on page 6------

XI. FINANCIAL INFORMATION(optional):

To be filled out only by those individuals whocannot pay the entire $3,500 tuition and wish to be considered for a scholarship.

FIRST NAME ______LAST NAME ______

ADDRESS ______

______

TELEPHONE (_____) ______

NUMBER OF CHILDREN ______

AGES ______

OCCUPATION ______

YEARS IN POSITION ______

ANNUAL GROSS SALARY ______

MARITAL STATUS ______

SPOUSE ANNUAL GROSS SALARY ______

I UNDERSTAND THAT NAPALL WILL ONLY USE THIS INFORMATION TO CONSIDER THE REQUEST AND NEED FOR A SCHOLARSHIP. I ATTEST THAT TO THE BEST OF MY KNOWLEDGE, ALL INFORMATION ON THIS FORM IS ACCURATE AND COMPLETE.

PRINT NAME ______

SIGNATURE:______DATE ______

Please submit form with your application by email to

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