Student Leadership Institute Application
Dear Student,
We are very excited that you are taking the time to complete the application for the Student
Leadership Institute.
Now that you are getting ready to send in your application, make sure you meet the eligibility
requirements and have completed the following:
Eligibility Requirements
□ Must be a matriculated student of Empire State College
□ Must have 2.0 Cumulative GPA or higher
□ Must have completed at least one term with the college prior to the September 2015 term
(2015FA1)
Application Checklist
□ Fill out the demographic information in the the ESC Student Leadership Institute Application
packet.
□ Type out your Open Response Essay. If essay is more than one page long, make sure your
name appears on all pages.
□ Sign and date the second page of the ESC Student Leadership Institute Application.
□ Seek a professional or educational recommendation and provide them with a copy of the
form they need to complete.
□ Submit application, open response essay and signature page to the Office of Collegewide
Student Services.
□ Make sure your reference has submitted the required materials to the Office of
collegewide Student Services.
□ Confirm receipt of all application materials.
Thank you for your interest in the Student Leadership Institute and we will notify applicants no later than
August 10, 2015.
Sincerely,
The ESC Student Leadership Institute Committee
Student Leadership Institute
Deadline: July 6, 2015 by 5 p.m. EST
Demographic Information
Name: _________________________________
ESC Student ID #:_________________________
Email Address: _________________________________________
Address: Street: ___________________________
City: _______________State: ______
Zip: ________
GPA: __________
Phone: __________________________________
Expected Year of Graduation: ______________
Area of Study: ___________________________
___________________________
Center/Unit: ____________________________
Degree being perused: ____________________
Open Response about Your Interest in the Leadership Institute
Please answer the following question and attach to this application.
1. In 1,500 words or less, please complete a personal statement describing your interests,
life experiences and goals. Also speak to why you would like to participate in the
Leadership Institute and what you hope to gain from it.
Student Leadership Institute
Deadline: July 6, 2015 by 5 p.m. EST
By signing below, I acknowledge the information provided to be complete and accurate to the best of
my knowledge. I also give permission to SUNY Empire State College to publish the participants of the
leadership institute in any media formats.
______________________________ ________________________________ _________________
Print Name
Signature
Date
Completed applications can be returned to the Office of Collegewide Student Services via:
Mail Service:
Empire State College
Attn: ESC Student Leadership Institute
1 Union Ave
Saratoga Springs, NY 12866-4310
Email: Please sign and scan your application form.
Student.Leadership@esc.edu
Fax:
Please attach a cover letter with fax.
518-587-9716
Student Leadership Institute Recommendation Form
Professional or Educational Reference
Deadline: July 6, 2015 by 5 p.m. EST
Name: ______________________________
Applicant’s Name: _______________________
Email Address: _______________________________
Phone: _________________________________
Relationship to Student: ________________________________________________________________
Recommendation
Please attach recommendation to this form.
Discuss the Empire State College student’s character, dedication and how you think they might
benefit from the Student Leadership Institute.
Unless otherwise requested, all applicants will receive a copy of the recommendation.
By signing below I acknowledge the above information to be complete and accurate to the best of my
knowledge. I also give permission to SUNY Empire State College to publish information about the
leadership institute participants in any media format.
______________________________ ________________________________ _________________
Print Name
Signature
Date
Completed forms can be returned to the Office of Collegewide Student Services via:
Mail Service:
Empire State College
Attn: ESC Student Leadership Institute
1 Union Ave
Saratoga Springs, NY 12866-4310
Email: Student.Leadership@esc.edu
Sign and scan your nomination.
Fax: 518-587-9716
Attach a cover letter with the fax.
Office Use: Student ID: ___________________ Other: ___________________________________
Note: Recommendation should be sent to Collegewide Student Services by the recommender. Applications received from
the applicant will not be considered valid unless received in a sealed and signed envelope.