<p> BLOOMBERG INNOVATION DELIVERY FELLOWSHIP APPLICATION</p><p>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. </p><p>Contact Information</p><p>First Name ______Middle Name ______Last Name ______Email Address ______Alternate Email (optional) ______</p><p>Mailing Address where you prefer to receive communications about the fellowship:</p><p>Street Address Line 1 ______Street Address Line 2 ______City ______State ______Zip Code ______Phone Number ______</p><p>Cities of Interest</p><p>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.</p><p>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</p><p>References Please use the Fellowship Reference Form to submit one reference letter and provide the following information for two additional references:</p><p>First and Last Name #1 ______Organization, Title ______E-mail ______Phone Number ______Relationship to applicant ______</p><p>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 ______</p><p>Short Answer Essays</p><p>Please answer the following questions in approximately 500 words each.</p><p>1. What motivates you to pursue a career in the public sector? </p><p>2. What makes you ready to serve as a Bloomberg Innovation Delivery Fellow?</p><p>Optional Information</p><p>Gender Male Female</p><p>How would you describe yourself?</p><p>African Asian/Indian American/African/Black/ Caucasian Caribbean American Biracial/Multiracial Asian American/Asian/Pacific Other: Islander ______Latino/Hispanic ___</p><p>How did you hear about the Bloomberg Innovation Delivery Fellowship? ______</p><p>______</p><p>Please email the following application materials to at [email protected] by November 15, 2011: </p><p> completed application as a Word or PDF document  your resume in a Word document or PDF</p><p>Please follow-up with your reference to ensure that the Fellowship Reference Form is submitted by the deadline to [email protected].</p><p>More information is available online at wagner.nyu.edu/leadership/leadership_dev/bidf.php</p><p>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].</p><p>Research Center for Leadership in Action, NYU Wagner, 295 Lafayette St, 2nd Floor, New York, NY 10012 </p>