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Subject: [NIFL-WORKPLACE:2530] National Adult Learner Leadership Institute Application
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APPLICATION TO PARTICIPATE IN THE VALUE
ADULT LEARNER LEADERSHIP INSTITUTE
Indianapolis, Indiana
June 3-5,1999
Adult learners are invited to apply to participate in VALUE’s Adult
Learner Leadership Institute. (For details about the Institute, see
accompanying description or contact the VALUE office below.)
Please return this form to VALUE (c/o Learning Partnerships, 14 Griffin
Street, East Brunswick, NJ 08816-4806, 732-254-2237) no later than March
15, 1999. (Use extra paper if you need to.)
Applicant’s Name ______________________________________
Address _________________________________________________
_________________________________________________________
Telephone _________________________(home)
_________________________ (work)
Fax ______________________________
E-mail ____________________________
To help us get a diverse mix of participants, please provide the
following information:
1. Age:
2. Gender:
3. Race/ethnicity:
4. Type(s) of adult education program(s) you have participated in (For
example: volunteer tutoring program, school-based adult education
program, English for speakers of other language program, workplace
education program, union education program, etc.
5. Dates when you participated in that program(s)?
6. What experience do you have as a leader in an adult literacy or
English for speakers of other language program education program
7. Have you ever been part of an adult learner organization (i.e., a
group run by adult education students)? (Explain.)
8. What do you know about VALUE? (Explain.)
9. Why do you want to participate in the Adult Learner Leadership
Institute? (What do you hope to learn or accomplish by attending?)
10. If you are selected to participate in the Institute, will you be
able to pay for your travel, hotel, meals, and a registration fee of
$110? (Explain.)
11. Whether or not you are selected for the Institute, would you like to
become a member of VALUE? (We are offering free introductory
memberships to adult learners until September 1st, 1999.)
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