For details on the
selection process, see your official
invitation (in PDF).
Team Key Contact
Name
Organization
Title
Address
City State
Zip
Phone
Fax
Email
Additional 2-4 team members and contact info.
2 Name
Organization
Title
Address
City State
Zip
Phone Fax
Email
3
Name
Organization
Title
Address
City State
Zip
Phone Fax
Email
4
Name
Organization
Title
Address
City State
Zip
Phone Fax
Email
5
Name
Organization
Title
Address
City State
Zip
Phone Fax
Email
1. Roles of
clinic planning team
Please
describe the roles each of your team members will play in the
development of your clinic.
2. Prior
Leadership Clinic experience
Please
describe
the experience of team members in either planning and/or attending
previous Leadership Clinics or other innovatively designed
conferences.
3. Dates of
your Clinic
Please provide the dates of the clinic you are planning.
(Please select
one)
confirmed
projected
4. Location
and Participants
Where are you planning to
hold your Leadership Clinic?
Who have
you/will you be inviting to your clinic?
5. Purpose
of Clinic
What is your primary objective in holding a leadership clinic?
What do you
hope to achieve collectively and what will each participant and team
take away from your clinic?
6.
Relationship of Clinic to EE Capacity Building
How will your clinic relate to the effort to build EE capacity in
your state or region?
2005 Leadership Clinic
