Placement Host Form: 2019-2020 Coro Fellowship

Thank you for committing to host a Fellow for a placement at your organization. I anticipate that you are an accomplished leader in your field and are deeply committed to your work, and I greatly appreciate your sharing this with our Fellows this year. As aspiring change makers, our Fellows are eager to bring their expertise, fresh ideas, and quality work to bear on your project and organization.

This Placement Host Form will take about 10 minutes of your time, and will help us best match you with a Fellow. To make this process as streamlined as possible, we ask that you complete this form as soon as possible and at least three weeks prior to the placement start date.

We appreciate your support of the Fellows Program and of Coro New York Leadership Center, and thank you for providing this important development opportunity for Fellows who aspire to work and lead change in the future of NYC.

My best,

Scott Millstein

Executive Director, Coro New York Leadership Center

Contact Information

First Name

Last Name

Title

Department

Organization

E Mail

Work Telephone

Cell Phone

There are 4 placement cycles based on sector and 1 placement (Independent) based upon a Fellow's request. There is also a Placement Fee payable to Coro NY Leadership Center, which is a critical support to the Fellows Program and each Fellow's stipend. The fee ranges depending on Placement sector. Please note that no payment is to be made from Host to Fellow. Please select for which placement cycle you are requesting a Fellow(s):

My organization has been a Placement Host in the past

I have been a Fellow's supervisor in the past

I will be the Fellow's Placement Supervisor

If yes, what is your supervisory style?

Supervisor Information (if a person other than you)

First Name

Last Name

Title

Department

E Mail

Work Telephone

Cell Phone

This person has been a Fellow's supervisor in the past

Supervisory Style

Organization's Information

Address

City

State

Zip

Reporting Location for first day (if different than address above)

City

State

Zip

Telephone:

(

)

Website

Workplace Dress Code

Fellow's Reporting Time for first day. Regular placement schedule will be negotiated with Fellow after first day.

My organization requires security clearance processes to be completed prior to the Fellows start date.

If yes, please provide more information including next steps and timeline.

I prefer a Fellow who speaks another language(s) in addition to English.

If yes, please indicate which language(s) would be preferred. Please note we may not be able to accommodate all requests.

Other Details/Comments:

Coro Fellow's Placement Project

Please briefly describe the project (3-5 sentences) that the Coro Fellow will be focused on during their placement with your organization. It is helpful to know what the project's purpose and desired outcomes are, as well as any specific skill sets required.

Project Description:

Next Steps!

The matching of the 12 Fellows with 12 placement hosts occurs up to two weeks prior to the placement and is based on a number of considerations including: the fit of the skills and professional development opportunities for the individual; the ability for the Fellow to provide value to the placement host via the proposed project; and the date the host application was submitted.

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