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Pennsylvania Bar Association

Bar Leadership Institute Application 2017-2018

|Your name: | |

|Job title: | |

|Name of firm or employer: | |

|Street Address: | |

|City, State and Zip Code: | |

|Work telephone: | |

|E-mail: | |

|Home address: | |

|Alternate phone number: | |

|Number of years in practice: | |

|You must be a member of the Pennsylvania Bar Association to be chosen to participate in the |

|Bar Leadership Institute. |

|Number of years that you have been a | |

|PBA member: | |

|The answers to the demographic questions are optional. They are of interest as we strive to build a diverse and inclusive class |

|based on age, gender, race/ethnicity, and other attributes. |

|Age: | |

|Gender: | |

|Race/Ethnicity: | |

Two Personal/Professional References are required.

***Please be sure to ask the references whom you have listed below to complete and return the candidate reference forms. We recommend that you download and forward a copy of the form to each of your references. The reference forms are available on the PBA web site at BLI.asp.

Reference 1

|Name: | |

|Title: | |

|Name of Firm or Employer: | |

|Street Address: | |

|City, State and Zip Code: | |

|Work Telephone: | |

|E-mail: | |

Reference 2

|Name: | |

|Title: | |

|Name of Firm or Employer: | |

|Street Address: | |

|City, State and Zip Code: | |

|Work Telephone: | |

|E-mail: | |

Please attach the following:

1. An updated resume.

2. A written statement of 500 words or less, describing why you want to be a member of the PBA Bar Leadership Institute Class of 2017-2018.

3. Any additional information which you would like to have considered when reviewing your application, including, but not limited to, bar association membership and activities, other association or organizational membership and activities, community service activities and leadership positions.

Required Meetings

The Bar Leadership Institute extends over a seven month period and requires that you participate in the following meetings:

❑ July 26-28, 2017, Young Lawyers Division Summer Meeting, Penn Stater Hotel, State College, PA

❑ November 15 – 17, 2017, Board of Governors, Committee Section Day, House of Delegates Meetings, Harrisburg, PA

❑ February 23 – 24, 2018, Conference of County Bar Leaders (CCBL), Lancaster Marriott at Penn Square, Lancaster, PA

The costs of attending these three required meetings (rooms, meals provided at the events and registration fees) will be paid by the Pennsylvania Bar Association. Travel expenses to and from the meetings are not covered by the PBA.

By submitting this application packet and typing my name below, I am indicating that I would like to be considered for the Pennsylvania Bar Association Bar Leadership Institute Class of 2017-2018 and I commit to completing the full program if chosen to be a member of the Bar Leadership Institute.

|Type your full name: | |

Please e-mail the completed candidate application packet by May 5, 2017 to:

Susan Etter (susan.etter@)

If you have questions, Susan can be reached by email or telephone: (800) 932-0311 ext. 2256.

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