NABM Emerging Leaders Application

Registrant Name Registrant Name

Email Email

Business Phone Business Phone

Cell Phone Cell Phone

Year Licensed as a Randolph-Sheppard Vendor Year Licensed as a Randolph-Sheppard Vendor

Describe your involvement with blindness consumer groups, civic organizations, advisory councils and other related organizations/groups Describe your involvement with blindness consumer groups, civic organizations, advisory councils and other related organizations/groups

Explain why you want to participate in the Emerging Leaders Program: Explain why you want to participate in the Emerging Leaders Program:

Describe any leadership roles you have held in the past: Describe any leadership roles you have held in the past:

Describe your aspirations as a future leader: Describe your aspirations as a future leader:

Explain how you expect this training to help you achieve your goal to be a leader: Explain how you expect this training to help you achieve your goal to be a leader:

Explain the traits that you possess that would make you an effective leader: Explain the traits that you possess that would make you an effective leader:

Explain what you see as the number one challenge facing today's Randolph-Sheppard Program: Explain what you see as the number one challenge facing today's Randolph-Sheppard Program:

In your own words, explain how the BEP Director in your state might describe you: In your own words, explain how the BEP Director in your state might describe you:

In your own words, explain how your fellow Blind Entrepreneurs would describe you: In your own words, explain how your fellow Blind Entrepreneurs would describe you:

Please provide any other information that you feel would be pertinent for the section committee to consider when reviewing your application: Please provide any other information that you feel would be pertinent for the section committee to consider when reviewing your application:

label Please provide the names and contact information for 2 references who could best describe your potential as a leader:

Reference #1

Name Name

Phone Phone

Email Email

Reference #2

Name Name

Phone Phone

Email Email

Verificationlabel

NABM Emerging Leaders Application

Reference #1

Reference #2

Verification

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