For year 2012-2013

The submission deadline is June 18, 2012, by 5:00 p.m.
Notices will be sent to applicants regarding their selection status in August 2012. If you have any questions, please email leadershipinstitute@azbar.org. Thank you.

Please complete the following form. You will need to upload your resume in either PDF or Word format. Because all form fields are required, please complete the form in its entirety before clicking on the “Submit” button at the bottom.

Name
State Bar Number
Date of Admission  
Employer / Firm Name
Mailing Address:
 
City/State/Zip: ,
Business Phone  
Email Address
Primary areas of practice
Please describe any prior leadership positions, activities, or training you have participated in, whether in the general or legal community:
Please explain why you would like to participate in this program and what you believe you may gain:
What skills, qualities, attributes and/or prior experience do you possess that you believe will be beneficial to the Leadership Institute?
Upload your resume:
CONFIDENTIAL

In order to select individuals who will achieve diversity and broad representation in the Leadership Institute,
we are giving you the opportunity to complete this portion of the application.

Please indicate which one of the following categories used by the EEOC best describes you.

Your Gender [check one]
Male
Female
Your Ethnicity [check all that apply]
Asian
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Black or African American
Filipino
Hispanic or Latino
Origins in Indian subcontinent
Caucasian
If the above designations do not best describe you,
please set forth the description you prefer:
Should you wish to identify other aspects of diversity, please check all that apply to you:
Sexual Orientation
Gender Identity and Expression
Disability
Other - please describe:
REFERENCES

Please provide the names and contact information of five people you have worked with in the past and are in a position to provide a professional referral.
  Name: Area Code: Phone: Email:
1)
2)
3)
4)
5)

By submitting this application I agree to the following:

  • I am aware that at least 42 hours of full participation in all the scheduled events between September 2012 and May 2013 are expected if I am accepted into this program.
  • Failure to participate may result in my dismissal from the program. I am also aware that, upon completion of the program, I am committing to one year of participation in the State Bar in some capacity (be it on a committee, section, or by special appointment), and/or participation in another bar association or community organization.