State Bar of Arizona
2013 Leadership Institute Application

The submission deadline is June 28, 2013, by 5:00 p.m.

Notices will be sent to applicants regarding their selection status in August 2013. If you have any questions, please email the State Bar of Arizona Leadership Institute.

Thank you.

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

GENERAL

Bar Number
Full Name
Date of Admission
Employer/Firm Name
Mailing Address

City
State Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Deleware DC Florida Georgia Hawaii Idaho Illinois Indianna Iowa Kansas Kentucky Louisiana Maine Maryland Massachusets Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code
Phone (555) 555-5555
Email
Primary area 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 resume (PDF or Word only)

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 of the following categories used by the EEOC best describes you.

Your GenderMaleFemale

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Your Ethnicity

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
Other Ethnicity

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Should you wish to identify other aspects of diversity, please check all that apply to you.

Sexual Orientation
Gender Identity and Expression
Disability

Other Diversity

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	Phone	Email

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 2013 and May 2014 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.

QUESTIONS?

Should you have any questions reguarding your application or this process, please contact:

Elena Nethers
Diversity and Outreach Advisor
State Bar of Arizona
4201 N. 24th St., Ste. 100
Phoenix, AZ 85016-6266
602.340.7393