Energy Instructor Fellowship Application Form

Name

Employer

Title

Address

City

State

Zip Code

Phone

Email

Number of Years an AAPL Member

RL/RPL or CPL# (if applicable)

State Bar Membership (if applicable)

Degree/Year/University (if applicable)

Education Presentation Experience

(Please note presentations, include the year, event name, topic, and number of people in attendance.)

Prior Employers

(List name, years and title)

If other, please specify.

Experience

(Please list regions and years)

References for This Role

(Please list name of contact, city, state, phone number, and/or email)

Are you available to attend 3 to 5 educational events in the next 10 months?

(Usually requires a travel day, an instructional day and a return travel day)

YesNo

If no, please describe any conflicts or issues.

Are you available to conduct 3 to 5 educational events over the next 4 years? YesNo

If no, please describe any conflicts or issues.

General Comments or Questions

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