DATE OF BIRTH PLACE OF BIRTH
HISPANIC SUB-GROUP Mexican Puerto Rican Cuban Other

Please attach a resume detailing your previous jobs, titles, dates of employment and areas of responsibility, current job responsibilities,
professional accomplishments and acquired skills. Also include your community affiliations, honors and awards.

PRESENT EMPLOYER # OF YEARS
Non-Profit Government Corporate Elected Self Employed
Other
CURRENT POSITION

BUSINESS ADDRESS

BUSINESS TELEPHONE BUSINESS FAX
E-MAIL
SUPERVISOR'S NAME

ANNUAL SALARY (check one)
Less than $30,000 $30,001 - $50,000 $70,000 - $100,000 $50,001 - $70,000 $100,001 or More

How did you learn about the National Hispana Leadership Institute?

NHLI Fellow NHLI Alumna NHLI Board Member NHLI Newsletter/Media
Other

Do you have any physical limitations or handicaps requiring special accommodations?

EDUCATION

A. Please list your educational background (traditional) including program and professional institutes, etc., dates attended and highest level completed.

B. What obstacles did you overcome to attain your education?

C. What are the most important lessons you learned from your formal education?

CAREER & PERSONAL GOALS

A. What are your short term professional and personal goals?

What is your plan for achieving them? (List up to 3)

Where would you like to be three to five years from now?

What are your long term professional and personal goals?

B. Please list and briefly describe your three greatest strengths.

C. Please list and briefly describe your three areas for improvement.

D. Please list and briefly describe three things about yourself you would most like to change.

COMMUNITY/CIVIC INVOLVEMENT

A. List up to three important community, religious or civic activities in which you have participated in the past five years. Indicate your level/type of involvement and why these activities are especially important to you.

B. On average, how many hours per week do you spend on community or civic volunteer activities separate from your current employment?
Hours/week

C. What has been your greatest contribution to the advancement of Hispanic women?

ISSUE ANALYSIS

The Latino community faces many socioeconomic, cultural and political challenges. Please identify one policy area of particular interest to you (i.e. immigration, education, health care, employment, etc.. (Attach your response on a separate sheet)

1. Summarize 3-4 important issues pertaining to this policy area, that consequently impact the Latino community.
   

2. Describe what you believe needs to happen at the policy, program and/or community levels to address the issues.
   
   

3. Indicate how your participation in the NHLI program will enhance your ability to address the issues.
   

PERSONAL

Please describe your childhood and family background. How did it influence and shape who you are today personally, professionally and as a leader?

LEADERSHIP

A. How do you define leadership?

B. What do you consider to be the five most important qualities or characteristics of a leader?

C. Do you believe Latina leaders are different from other leaders? Yes Not Sure No
If yes, how? If no, why not?

D. What kind of leadership roles would you like to be carrying out five to ten years from now? Be as specific as possible.

E. List three ways in which this program can help you become the leader you want to be.

CONTRIBUTIONS

A. Why should you be selected for this program? What would you contribute to the group?

B. NHLI expects that its Alumnae will continue to support the Institute through community activities, volunteerism, financial contributions, etc. If you are selected for the program, how will you continue to support the NHLI, as an Alumna, in order to assure that other Latinas have the opportunity to participate in our program?

C. How will your participation in the NHLI program benefit the Hispanic community and/or other Latinas?

I certify that all information and statements in this application are true and correct to the best of my knowledge. I understand that the information in this application may be verified. If selected, I will send NHLI the $3,000 tuition fee on or before the deadline of January 1, 2001 to reserve my place. If selected, I will participate in all training sessions, contribute to the best of my ability, mentor two Hispanic women and complete a leadership project as a part of my commitment to the National Hispana Leadership Institute.

Signature
Date

PLEASE NOTE: Tuition is non-refundable and non-transferable.

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FINANCIAL INFORMATION (optional)

To be filled out only by those individuals who cannot pay the $3,000 tuition and wish to be considered for a partial scholarship (maximum of one third of $ 3,000 tuition fee).

NAME (Last, First, Middle or Maiden)
SOCIAL SECURITY NUMBER Age Marital Status
HOME TELEPHONE NUMBER

HOME ADDRESS (Include City and Zip Code)

#of children Ages of children
Your occupation Annual gross salary
Yrs. in current position
If married, your spouses's occupation
Spouse's annual gross salary Yrs. in current position

I understand that the NHLI will only use this information to consider my request for a partial scholarship.
I attest that to the best of my knowledge, all information on this form is accurate and complete.

Signature
Date

NHLI Recommendation Form

The National Hispana Leadership Institute is seeking Hispanic women of exceptional potential and ability from across the United States. The NHLI will appreciate your commenting as completely as possible regarding the candidateÍs strengths and limitations. Please answer the four questions below and if you need more room use separate sheet of paper.

Please Fill out and print this document.

Mail or fax your completed application to:
NATIONAL HISPANA LEADERSHIP INSTITUTE
1601 North Kent Street, Suite 803 • Arlington, VA 22209
Phone: 703-527-6007 FAX: 703-527-6009

APPLICANT'S NAME:

YOUR NAME:
TITLE:
SIGNATURE:
ORGANIZATION:
COMPANY ADDRESS:

OFFICE TELEPHONE: FAX:
E:Mail :

 

Please answer the questions below to the best of your abilities.
(Use additional sheeets of paper if necessary to answer questions.)

1. How are you acquainted with the applicant? How long have you known her?

2. The NHLI Leadership Fellows Program is an initiative to help prepare women for top leadership. Where do you see the applicant in her profession five years from now? What is her potential?

3. Please recount a project or other work-related situation which illustrates the applicantÍs strengths. What special talents and abilities set her apart from others in her field?

4. Please remark further on any aspect of the applicantÍs potential or personal qualities which might not appear elsewhere on the application. The NHLI is interested in your overall impressions of the candidateÍs suitability for this program, including evidence of her commitment to participate in all aspects and components of the Leadership Program. Part of this commitment is the applicantÍs intention to return to her community and profession as a Mentor at the end of the program year.   

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