sponsor endorsement form - Epfp - Institute for Educational Leadership

SPONSOR ENDORSEMENT 2015-16 PROGRAM YEAR
NAME OF APPLICANT_________________________________________________________
THIS FORM MUST BE COMPLETED , SIGNED , AND UPLOADED TO YOUR ONLINE APPLICATION. YOUR APPLICATION WILL NOT BE CONSIDERED
COMPLETE WITHOUT THIS DOCUMENT. APPLICATIONS RECEIVED UNTIL COHORT IS FULL. APPLICATIONS MUST BE RECEIVED BY JUNE 19, 2015.
ENDORSEMENT: TO THE SUPERVISOR/EMPLOYING AGENCY REPRESENTATIVE
Program Requirements
Global EPFP requires participation in monthly, two-hour online seminars from August 2015 – January 2016, which are held
during the normal work day hours. In addition, GEPFP Senior Fellows are expected to participate in the Bhutan Field Study,
October 21-31, 2015. GEPFP Senior Fellows have the option of completing a policy analysis on education policy in a
developing nation.
Applications for the 2015-16 program year -- along with a $675 deposit to secure your spot -- will be received until the
cohort is filled. All applications must be received by June 19, 2015. Accepted applicants must submit the $675 deposit no
later than July 1, 2015. (Note: $500 of the deposit is non-refundable upon cancellation.)
Program Fees and Employer Sponsorship
Each GEPFP Senior Fellow or the Fellow's employing agency–the sponsor–pays the participation fee of $4,875, which is
inclusive of program fees, domestic and international airfare, land transportation in Bhutan with guides and tips and
gratuities, daily breakfast, and accommodations. The employer also provides release time as needed for participation in the
Bhutan field study and other program activities
Additional Costs:
 Travel insurance
 Travel passport and tourist visas
 Medical release
 Personal items, alcohol, snacks, and meals
Full payment of the Participation Costs is due by August 1, 2015. Senior Fellows that have not paid the full
participation costs by August 21, 2015 will not be able to attend the Bhutan field study.
[Please note: Travel and health insurance for the international portion of the experience are required and are the sole
responsibility of each participant. Individuals are responsible for making their own international flight arrangements to
India and Bhutan through GEPFP’s New York, NY-based travel agency, Asian Vistas.]
Your signature ensures (1) your employee’s release time for full participation in the program, (2) your agreement to serve as
a sponsor to the Fellow throughout the program year, and (3) payment of the GEPFP Program Fee and all field study travel
costs by August 1, 2015. (Please note that if the applicant is bearing the financial responsibility for the program, he/she must
indicate this in his/her online application and is responsible for full payment of the GEPFP Program Fee and all field study
travel costs by the August 1, 2015 deadline.) If you have any questions, please contact the EPFP national office at the
Institute for Educational Leadership at (202) 822-8405 x139.
_______________________________________
Name of Applicant (PRINT)
_______________________________________
Applicant's Signature
(DATE)
_______ (If you are self-funded, initial here and skip the remaining portions of this form.)
_______________________________________
Supervisor's/Sponsor's Name (PRINT)
_______________________________________
Supervisor's/Sponsor's Signature
(DATE)
SPONSOR ENDORSEMENT 2015-2016 PROGRAM YEAR
Please complete the supervisor/sponsor contact information below.
Supervisor's Title ______________________________________________________________________
Supervisor's Division/Department
_____________________________________________________________________________________
Supervisor's Organization/Institution
_____________________________________________________________________________________
Supervisor's Office Address
_____________________________________________________________________________________
Supervisor's Office Phone ________________________________________________________________
Supervisor's Office Fax __________________________________________________________________
Supervisor's E-mail Address ______________________________________________________________
For more information about GEPFP, please visit: http://epfp.iel.org/?page=GEPFP