Excellence in Public Service Leadership: For State and Local Government Leaders Program Application

If you have any questions, please contact:

Jennifer Benbow jbenbow@ourpublicservice.org
or (202) 495-3339

*Please note, many agencies have specific application guidelines for their employees. Before submitting your application, please make sure that you are following your agency’s internal guidelines and that you have permission from your agency’s leadership to participate in this program.

Application Type

Personal Information

Salutation

First Name

Middle Name or Initial(s)

Last Name

Nickname

Job Title

Occupation

State

County or Municipality

Agency Name

Full State/ Local Agency Name

Please double check above that the full name of the agency is correct.

Work Phone

Mobile Phone

Home Phone

Preferred Phone Number

Work Email

Personal Email

Preferred Email Address

Work Address

Address Type

Street

City

State

Zip Code

Country

Home Address

Address Type

Street

City

State

Zip Code

Country

Emergency Contact Name

Emergency Contact Phone

Supervisor Information

Salutation

Supervisor First Name

Supervisor Last Name

Supervisor Job Title

Supervisor Phone Number

Supervisor Email

Street

City

State

Zip Code

Country

Professional Experience and Objectives

Total years of government service

Are you a leader of

ProjectsTeamsLeadersNone of the Above

Number of employees or projects you supervise

Numerals only

Please describe the projects you supervise:

Describe your current job responsibilities. Limit 300 words

Describe your short- and long-term career objective(s). Why is leadership development important at this point of your career? Limit 300 words.

Supervisor Endorsement Form

Your supervisor endorsement form must come from your direct supervisor. You may upload the file here (preferred) or email it directly to Jennifer Benbow at jbenbow@ourpublicservice.org. The file should be no larger than 1MB and no longer than two pages.

Supplemental Information

How did you learn about this training program?

Once accepted into this program, your non-refundable tuition payment will be required before the program start date. If you can no longer attend, you may defer your program registration for up to one year. For any questions or concerns about making payment before the program start date, please contact our team at invoice@ourpublicservice.org.

Limited spots are available. If the program is full at the time of your application, you will be placed on a waitlist or automatically enrolled in the next cycle. Our team will keep you updated about your enrollment status.

Contact Information

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