BLOOMBERG INNOVATION DELIVERY FELLOWSHIP APPLICATION
Please email your completed application as a Word document that includes your last name in
the file name, along with your resume, to wagner.innovationfellows@nyu.edu by November 15,
2011.
Contact Information
First Name
Middle Name
Last Name
Email Address
Alternate Email (optional)
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
Mailing Address where you prefer to receive communications about the fellowship:
Street Address Line 1
_____________________________________________
Street Address Line 2
_____________________________________________
City ___________________________ State ______________ Zip Code __________
Phone Number ________________________________________________________
Cities of Interest
The Bloomberg Innovation Delivery Fellowship requires a two-year full-time assignment to one
of the cities selected for the Innovation Delivery Team initiative. Please rate each city on a scale
of 1 – 5 according to the following statement.
I would be interested in being a member of the Innovation Delivery Team in this city:
Strongly Disagree Indifferent Agree Strongly Would you accept the
Disagree
Agree
fellowship award if
assigned to this city?
(Please check one)
Atlanta
1
2
3
4
5
Yes
No
Chicago
1
2
3
4
5
Yes
No
Louisville
1
2
3
4
5
Yes
No
Memphis
1
2
3
4
5
Yes
No
New
1
2
3
4
5
Yes
No
Orleans
References
Please use the Fellowship Reference Form to submit one reference letter and provide the
following information for two additional references:
First and Last Name #1
Organization, Title
E-mail
Phone Number
Relationship to applicant
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
Research Center for Leadership in Action, NYU Wagner, 295 Lafayette St, 2nd Floor, New York, NY 10012
First and Last Name #2
Organization, Title
E-mail
Phone Number
Relationship to applicant
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
Short Answer Essays
Please answer the following questions in approximately 500 words each.
1. What motivates you to pursue a career in the public sector?
2. What makes you ready to serve as a Bloomberg Innovation Delivery Fellow?
Optional Information
Gender
Male
Female
How would you describe yourself?
African American/African/Black/
Caribbean American
Asian American/Asian/Pacific Islander
Latino/Hispanic
Asian/Indian
Caucasian
Biracial/Multiracial
Other:
______________________________
How did you hear about the Bloomberg Innovation Delivery Fellowship?
________________________________________________________
________________________________________________________
________________________________________________________
_____________
Please email the following application materials to at wagner.innovationfellows@nyu.edu by
November 15, 2011:


completed application as a Word or PDF document
your resume in a Word document or PDF
Please follow-up with your reference to ensure that the Fellowship Reference Form is submitted
by the deadline to wagner.innovationfellows@nyu.edu.
More information is available online at wagner.nyu.edu/leadership/leadership_dev/bidf.php
For questions or additional information, please contact us at
wagner.innovationfellows@nyu.edu.
Research Center for Leadership in Action, NYU Wagner, 295 Lafayette St, 2nd Floor, New York, NY 10012