2006/2007 Executive Leadership Program Application
(To Be Completed by the Applicant)

Name  __________________________________________________________________________________________                                                                                                                                                 

Home Address (Kept confidential upon request)
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Work Address                                                                                                                                    
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Work Phone ________________Work Fax ________________Home Phone ____________________________
                                                                    
E‑mail__________________________________________________________________________________________

Title _______________________________________Series _______________Grade___________________________                              

Social Security Number_______‑________‑________	Education       ___ HS   ___AA     ___ BA/BS   ___Masters    

Years of Government Service________               

Immediate Supervisor's Name___________________________________________________________________________________                                                                                                    

Supervisor's Title ___________________________________Telephone Number______________________________                             

E‑mail ________________________________________________             

Supervisor's  Mailing Address  	                                                                                                
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Agency Program Coordinator ____________________________________________________________________________________                                                                                                              

Telephone Number__________________________ Fax Number_______________________________

E‑mail ________________________________________________   

Agency Program Coordinator Address   	                                                                                                            
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Purpose for Applying
(To Be Completed by the Applicant)

Part A: Please state your purpose for applying.  How will your participation in the New Leader Program support your career goals.

Evaluation of Performance
(To Be Completed by the Supervisor)
Narrative Evaluation of the Applicant's Performance: Please provide a written narrative of the applicant's current performance.

Supervisor's Signature_________________________________________________________________________________________

Supervisor's Title and Telephone Number__________________________________________________________                                                                                         

*All application materials must be submitted to the Graduate School, USDA through the appropriate agency channels and must be accompanied by an SF‑612, 171 or resume and an approved agency training form such as an SF‑182, 1556 or 350.  Letters of recommendation will also be accepted.