National Eagle Leadership Institute

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Corporate Bound Academy Application

The National Eagle Leadership Institute® welcomes your application for the 2004 session of Corporate Bound Academy™. The application deadline is October 1, 2004. For more information about Corporate Bound Academy, visit www.NELI.net. You can reach us at corporateboundacademy@neli.net, or via phone at 913.317.2888.

CHECKLIST

Before mailing your application, check your schedule. If selected, you must be able to attend the session, scheduled for Friday, November 19 and Saturday, November 20, 2004. Ensure that the following items are enclosed with your completed application. Incomplete applications will not be considered.

One letter of recommendation
A copy of your most recent transcript
$49.00 application fee

ELIGIBILITY

Corporate Bound Academy™ is open to student leaders who meet the following criteria.

African-American or Hispanic/Latino
Full-time junior or senior attending an accredited college or university within the continental U.S.
Minimum 2.8 GPA

MAILINGADDRESS

Submit application to the following address:

Corporate Bound Academy
c/o National Eagle Leadership Institute
7300 W. 110th Street
7th Floor
Overland Park, KS 66210

APPLICANTDATA
First Name:
Middle Initial:
Last Name:
Gender:male female
Campus/Dorm/Apt. Street Address:
City:
State:
Zip:
Phone:
E-mail:
Permanent/Home Street Address:
City:
State:
Zip:
Phone:
E-mail:
Emergency Contact Name:
Relation(e.g., mother, father, guardian):
Day Phone:
Evening Phone:
EDUCATION
Current Classification:Junior Senior
College/University Name:
Current Major:
Current Minor (if applicable):
Expected Graduation Date (month/year):
Cumulative GPA (on 4.0 scale):
Academic Advisor's Name:
Advisor's Direct Phone:
Advisor's E-mail:
WORKEXPERIENCE
Intended Career Field:
Work Experience (If applicable, list current and/or prior employers related to your intended career:
1.
2.
3.
Are you currently employed in an internship?Yes No
Company Name:
Internship Manager/Coordinator:
Manager's Direct Phone:
Fax:
E-mail:
Is it a paid internship?Yes No
Which term(s) are you working: spring semester summer fall semester
In what department do you work?
Briefly describe your job responsibilites:
STUDENTLEADERSHIP
List campus, community, or professional organizations in which you have held a leadership role.
1.
2.
3.
4.
List other activities in which you are involved.
1.
2.
3.
4.
NOMINATORDATA
Name:
Title:
College/University/Company:
Mailing Address:
City:
State:
Zip:
Direct Phone:
Fax:
E-mail:
If your nominee is selected for Corporate Bound Academy, will you agree to the following?
I/my organization will offer an excused absence for the program dates (Friday, Nov. 19 and Saturday, Nov. 20). yes no
My organization will sponsor transportation and/or hotel accommodations for our nominee.yes no
On official university or company letterhead, please attach a letter of recommendation describing your nominee's penchant for corporate leadership.
APPLICATIONFEE
Consideration for Corporate Bound Academy™ includes a non-refundable $49.00 application fee.
Select Payment Option: Visa Mastercard AMEX
Credit Card #:
Exp:
Name on Card:
Payment Terms* Payment must be received along with your application for processing. No personal checks please. NELI will accept university and company checks only. Personal cash payments must be in the form of a money order or cashier's check.
Hotel Accommodations Confirm hotel reservations direct with the Omni Orlando at ChampionsGate. Call toll-free, 1.800.400.1700. Mention NELI to receive a discounted rate of $169.00. This rate is valid until October 8, 2004.

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