Global Social Change Leadership Institute for Youth

BLOOMBERG INNOVATION DELIVERY FELLOWSHIP APPLICATION

Please email your completed application as a Word document that includes your last name in the file name, along with your resume, to [email protected] by 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 rate each city on 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 Indifferent Agree Strongl Would you accept the Disagree y Agree 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 1 2 3 4 5 Yes No Orleans

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 ______

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

2. What makes you ready to serve as a Bloomberg Innovation Delivery Fellow?

Optional Information

Gender Male Female

How would you describe yourself?

African Asian/Indian American/African/Black/ Caucasian Caribbean American Biracial/Multiracial Asian American/Asian/Pacific Other: Islander ______Latino/Hispanic ___

How did you hear about the Bloomberg Innovation Delivery Fellowship? ______

______

Please email the following application materials to at [email protected] by November 15, 2011:

 completed application as a Word or PDF document  your resume 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 [email protected].

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

Research Center for Leadership in Action, NYU Wagner, 295 Lafayette St, 2nd Floor, New York, NY 10012 For questions or additional information, please contact us at [email protected].

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