EMPLOYER AUTHORIZATION FORM
NFBPA - Executive Leadership Institute
NAME OF APPLICANT
*
First Name
Middle Name
Last Name
Suffix
NAME OF SUPERVISOR/AUTHORIZER
*
First Name
Middle Name
Last Name
Suffix
ORGANIZATION/AGENCY/DEPARTMENT
*
WORK ADDRESS
*
Street Address
Street Address Line 2
City
State / 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 2023
1 Virtual Orientation (2 hours)
January 2024
1 Virtual Session (16 hours/2 days)
1 Leadership Coaching Session (1 hour)
February 2024
1 Virtual Session (16 hours/2 days)
1 Virtual Learning Exchange (6 hours)
1 Leadership Coaching Session (1 hour)
March 2024
1 Virtual Session (16 hours/2 days)
1 Leadership Coaching Session (1 hour)
April 2024
1 In-Person Session (32 hours/4 days) Virtual Sessions (32 hours)
NFBPA Forum 2024, Baltimore, MD
1 Leadership Coaching Session (1 hour)
April 2024
1 In-Person Session (32 hours/4 days) Virtual Sessions (32 hours)
NFBPA Forum 2023, Minneapolis, MN
1 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, 2023.
NAME OF SUPERVISOR/AUTHORIZER
*
First Name
Middle Name
Last Name
Suffix
SIGNATURE OF SUPERVISOR/AUTHORIZER
*
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TODAY'S DATE
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