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* 1. Address

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* 2. Gender:

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* 3. Ethnicity or Race (optional; select one):

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* 4. Supervisor's Information

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* 5. What is your primary reason for wanting to participate in this program?

Career/Professional Development

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* 6. Completed probationary period:

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* 7. Taken the Intercultural Developmental Inventory (IDI)

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* 8. Enrolled or completed the Leadership Development Program (LDP):

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* 9. Are you a member or ally of an ERG:

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* 10. Length of Rotation/Mobility Requested:

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* 11. Please describe your two (2) strongest area(s) of experience:

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* 12. Please list three (3) areas where you need to develop your skills/knowledge in order to achieve our career objectives. (professional development plan).

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* 13. Please list four (4) skills you would like to acquire during the experience.

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* 14. Please list any duties or tasks that you would not be able to perform or accept in your rotation.

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* 15. Other comments that supports this application:

Applicant:  By signing the application the applicant confirms their interest in the ERG Rotation program and agrees to the application and selection process established by the Office of Equity and Diversity

Supervisor:  By signing the application the supervisor recognizes that the applicant will be reducing the hours spent on their home office work and may be physically moved from home location for the duration of the rotation.

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* 16. Participant Signature & Date:

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* 17. Approval of Supervisor (Signature) & Date:

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