IEL  The Institute for Educational Leadership, Inc.

4455 Connecticut Avenue, N.W.  *  Suite 310  *  Washington, D.C. 20008
(202) 822-8405  *  FAX: (202) 872-4050  * iel@iel.org  * http://www.iel.org/

EDUCATION POLICY FELLOWSHIP PROGRAM
APPLICATION

Biographical Data

Name (last, first, middle, nickname):

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Professional Title:

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Division/Dept:

_________________________________________________________________

Organization/Institution:

_________________________________________________________________

Address:

_________________________________________________________________
_________________________________________________________________

Office Phone: _(_____)_______________ext._______

Office Fax Number: ______(_____)_________________________

E-mail Address: ________________________________________

Home Address (street, city, state, zip):

_________________________________________________________________
_________________________________________________________________

Home Phone: _(_____)_________________________



Education

Please cite most recent institution first.

University/College City, State Major Field Degree Date
         
         
         
         

Optional Information

Race/Ethnicity & Sex:

_________________________________________________________________

How did you learn about EPFP?

_________________________________________________________________
_________________________________________________________________

 

Employment Experience

Please list current position first. Do not substitute this section with your resume.

Title:

_________________________________________________________________

Dates of Employment:

_________________________________________________________________

Name & Address of Employer:

_________________________________________________________________
_________________________________________________________________

Description of Duties & Accomplishments:

_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

 

Title:

_________________________________________________________________

Dates of Employment:

_________________________________________________________________

Name & Address of Employer:

_________________________________________________________________
_________________________________________________________________

Description of Duties & Accomplishments:

_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

Reason for Leaving:

_________________________________________________________________
_________________________________________________________________

 

Title:

_________________________________________________________________

Dates of Employment:

_________________________________________________________________

Name & Address of Employer:

_________________________________________________________________
_________________________________________________________________

Description of Duties & Accomplishments:

_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

Reason for Leaving:

_________________________________________________________________
_________________________________________________________________


EPFP™ Outcomes
Please provide narrative responses of one page or less to each of the following questions focused on the personal and professional outcomes of EPFP.

  1. What does your organization do? Whom do you serve?

  2. To enhance your capacity as a leader, what are your three learning priorities?

  3. How would your participation in EPFP™ benefit your organization?

Endorsement: To the Supervisor/Employing Agency Representative

Fellows generally participate in weekly or semi-monthly meetings conducted on-site and attend two four-day conferences that bring together Fellows from all EPFP™ sites. The first of these conferences, the National Leadership Forum, is held in the late fall, usually near one of the EPFP™ state locations, and the second is held in the early spring in Washington, DC. The program costs plus travel-related costs to both national meetings are paid by the employing agency and/or the Fellow. Your signature ensures (1) your employee's release time for full participation in the program and (2) payment of program related costs. If you have any questions, please contact the EPFP™ Coordinator in your area or call the National Office, the Institute for Educational Leadership, in Washington DC at (202) 822-8405.


Name of applicant:

_________________________________________________________________

Applicant's signature:

_________________________________________________________________


Supervisor/Sponsor's Name:

_________________________________________________________________

Supervisor/Sponsor's Signature:

_________________________________________________________________


Supervisor's Title:

_________________________________________________________________

Supervisor's Division/Dept:

_________________________________________________________________

Supervisor's Organization/Institution:

_________________________________________________________________

Supervisor's Office Address:

_________________________________________________________________
_________________________________________________________________

Supervisor's Office Phone: __________________

Supervisor's Office Fax: ____________________

Supervisor's E-mail Address: ________________