The Community Fellows Program
Courses begin September 25, 2013.
A completed application includes the following:
  • current resume
  • one letter of recommendation
  • one nomination letter from your executive director
    Your Director’s nomination letter should address the following:
    • potential for leadership
    • current skills and those that need development
    • reliability
    • leadership style of your nominee: quiet; lead by action; articulate, charismatic; etc.
    • commitment to social justice and diversity
    • ambition
    If you or your Director has questions about this nomination letter, please contact Barry Dym at bdym@bu.edu
  • statement of purpose
  • short biography (examples)
  • statement of your major job responsibilities
Upon receipt of completed application, applicants will be contacted to arrange a mandatory interview at the School of Management.

Please review the application form below and gather all needed information before starting the application process. The admissions committee will only review complete applications.
Personal Information (* required information)
* Email  
* Confirm Email  
* First Name    
Middle Name
* Last Name  
* Salutation             Suffix
Boston University degree and year, if applicable
* Country of Citizenship
Format US numbers as XXX-YYY-ZZZZ. Include country codes for international numbers.
* Phone number  
Fax
Primary State of Licensure
NASW membership number if applicable
Secondary State of Licensure      


Office Information (* required information)
Organization  
* Office Address 1  
Office Address 2
* City  
* State/Province
* Zip/Postal Code  
* Country


 Preferred Mailing Address (*Please indicate where to mail your materials.)
Use my Office Address
Use the Preferred Address below.
Preferred Address Type  
* Preferred Address 1  
Preferred Address 2
* City  
* State/Province  
* Zip/Postal Code  
* Country  


General Information (* required information)
* Sector Type  
* Sector Type if Other  
* Years in Practice  
* Number Of Staff Working In Your Organization
* Number Of People You Manage  
 
* Number Of Programs You Manage  
 
* How did you hear about this program  
* Gender
  
* Name for certificate
* Emergency contact First Name
* Emergency contact Last Name
* Emergency contact phone
 
* What are the major responsibilities of your job?
 
* Briefly describe the major management and leadership challenges in your organization?

* Statement of purpose - briefly assess how you or your staff would stand to benefit from a year-long intensive leadership program?
 
* Please provide a short bio to share with other participants. Describe your current position, responsibilities,
company, company profile, previous work experience, and educational background. Examples.
 
*  Please provide a recent version of your resume or c.v. in PDF or MS Word (.doc, or .docx) format.
Click on the Browse button to select a file to upload.


Recommendation & Nomination (* required information)

Please submit one letter of recommendation and one nomination letter. The recommendation letter should be from a peer or someone who knows your professional work. The nomination letter should be from your executive director.

Both letters can be submitted via email to bbooras@bu.edu, via fax to 617-353-3477 or via US mail to the following address:

BU School of Management
Executive Leadership Center
595 Commonwealth Avenue, Suite 404
Boston, MA 02215
Attn: Allyson Clancy
* Board Chair or Executive Director  
* Peer  


 Special Needs (* required information)
Special Needs: We are in full compliance with the legal requirements of the Americans with Disabilities Act rules and regulations. If you have any disability-related needs, please explain below. If it is within three weeks of the activity date please call 617.353.4248.

wheelchair   		 Do you have a disability which may     Yes No
require special services?
     

 Dietary Needs (* required information)
Do you have food allergies or other dietary needs?
Yes  Please describe:   No
     

Please specify your race/ethnicity:
* if Other     
 
* A photographer will be onsite. May we have your permission to take your photograph in conjunction with the conference for use in our marketing materials?
   Yes     No

If you have questions regarding registration, please contact the Executive Leadership Center by calling: 617.353.4248 between the hours of 9:00 AM - 5:00 PM EST Monday through Friday OR by Email.
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