Construction Leadership Institute



Southern Illinois University Edwardsville

School of Business and

Department of Construction, School of Engineering

Construction Leadership Institute

January 12, 2018 – March 9, 2018

Please type or print clearly in black ink.

Applicant Information

Name:

Signature:

Company Name:

Current Position or Title:

Mailing Address: (Please include a physical address and P.O. Box)

Telephone: Fax:

Email Address:

Beginning with your current employer, provide a brief summary of construction experience over the past six to eight years. Include employers, dates of employment, and a description of responsibilities with emphasis on your current duties.

List undergraduate and graduate degrees earned, continuing education programs attended, construction-related courses and examinations passed, and certificates received. (Degree/Certif./Course Program) (Major/Concentration) (Awarding Body) (Date)

Company Information

General Contractor ( Specialty Contractor ( Other (

AGC Member: Yes ( No ( SIBA Member: Yes ( No (

Primary Areas of Construction Activity:

Building: % Municipal-Utilities: %

Highway: % Other: %

Heavy-Industrial: % Collective Bargaining: %

Open Shop: %

Approximate Annual Volume of Work Put in Place by the Firm in 2016: $

Sponsor Information

Name:

Company Name (if different):

Title:

Address: (Please include a physical address and P.O. Box)

Telephone: Email Address:

Attach a letter of endorsement from a principal or the chief executive officer of your firm. This letter should relate the writer’s personal knowledge of your qualifications and suitability for admission to the program. A sample Letter of Endorsement can be downloaded from the Construction Leadership Institute website at: siue.edu/cli, or contact Kristine Jarden at 618-650-2668 or kjarden@siue.edu. (If applicant is the chief executive of the firm, omit this requirement.)

Application may be submitted electronically to kjarden@siue.edu and payment made using the secure online credit card transaction processing available on the CLI website at: , or by check made payable to Construction Leadership Institute; SIUE.

Tuition Fee Schedule: $2950 if payment received on or before November 1, 2017

$3150 if payment received after November 1, 2017

Application Deadline: December 1, 2017

MAIL TO: Construction Leadership Institute

Attention: Kristine Jarden

SIUE School of Business

Campus Box 1051

Edwardsville, Illinois 62026

Phone: 618-650-2668 Fax: 618-650-5353

Email: kjarden@siue.edu

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