EMPLOYER AUTHORIZATION FORM

EMPLOYER AUTHORIZATION FORM

NFBPA - Executive Leadership Institute
Your employee is applying to the National Forum for Black Public Administrators (NFBPA) Executive Leadership Institute (ELI) in partnership with Georgetown University, a professional development program designed to strengthen leadership, management, and public service impact. This form confirms your organization’s authorization for the applicant to participate and, if accepted, to attend required sessions and complete program assignments.
NAME OF APPLICANT*

First NameMiddle NameLast NameSuffix
NAME OF SUPERVISOR/AUTHORIZER*

First NameMiddle NameLast NameSuffix
ORGANIZATION/AGENCY/DEPARTMENT*
WORK ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
EMAIL ADDRESS*
example@example.com
PHONE NUMBER*
Please enter a valid phone number.
CERTIFICATION
I certify that:
- My agency/department/organization understands the financial and time commitments associated with the National Forum for Black Public Administrators Executive Leadership Institute.
  - Tuition - $11,360
  - Time Commitment:
    
    December 2025 - TBD
    
    Virtual Orientation (2 hours)
    
    January 2026 - TBD
    
    Virtual Session (16 hours/2 days)
    
    Leadership Coaching Session (1 hour)
    
    February 2026 - TBD
    
    Virtual Session (16 hours/2 days)
    
    Leadership Coaching Session (1 hour)
    
    March 2026 - March 7-11, 2026
    
    In-Person Session (32 hours/4 days) NFBPA Forum 2025, Philadelphia, PA (Tuition includes full FORUM registration; however, travel and hotel accommodations are not included.)
    
    Leadership Coaching Session (1 hour)
    
    April 2026 - TBD
    
    Virtual Session (16 hours/2 days)
    
    Leadership Coaching Session (1 hour)
    
    May 2026 - TBD
    
    In-Person Session (32 hours/4 days) at Georgetown University, Washington, DC (do not include travel & hotel accommodations.)
    
    Leadership Coaching Session (1 hour)
- I will allow my employee to participate in the Executive Leadership Institute Sessions as they occur and I approve of this professional development opportunity;
- My organization has identified the funding and will remit the funding in full by December 1, 2025.
NAME OF SUPERVISOR/AUTHORIZER *

First NameMiddle NameLast NameSuffix
SIGNATURE OF SUPERVISOR/AUTHORIZER *

Clear
TODAY'S DATE*

MonthDayYear
Should be Empty:

EMPLOYER AUTHORIZATION FORM

CERTIFICATION