Stryker Institute for Leadership Development
First Name:
Middle Name:
Maiden Name:
Last Name:
Date: MM/DD/YY
Phone:
Email:
Cohort Year:
Ethnicity:
Major:
Graduation Date or Anticipated Graduation Date:
Address:
City:
State:
Zip Code:
How many years did you participate in the Stryker Institute?
What is your current enrollment status?
Highest educational level attained?
Are you currently employed outside the home?
If so, please provide the following information:
Place of Employment:
Position Held:
Nature of your work:
With what community and/or volunteer organizations are you currently associated? Please list.
Please list any leadership positions and/or endeavors you have undertaken since your participation in the Stryker Institute.
Was your Stryker Institute scholarship/grant the first time that someone you did not know made an investment in you and your future?
Yes
No
I believe my participation in the Stryker Institute made, or is making, a substantial difference in my ability to attend and complete my post secondary education.
I would describe my opportunity through the Stryker Institute as a “life changing” experience.
Based on my Stryker Institute experiences, I believe I will be more likely to invest my time, talents, and leadership abilities in serving others in order to “make a difference” in their lives and our communities.
Please give us some examples as to how the Stryker Institute has influenced or impacted you during your time in the program and beyond.
How have the leadership skills that you cultivated while participating in the Stryker Institute empowered you within your family, job, or community?
Would you be interested in being contacted to volunteer with Stryker or Women’s Resource Center events or programs?
Stryker is developing a Facebook page. Are you on Facebook?
If so, how often do you access it?
Do you know of anyone that you would like to refer to the Stryker Institute?
Name: