Exit
SurveyMonkey does not allow progress to be saved. To ensure you answer the application questions to the best of your ability, we recommend typing out your essay responses on a document and then copying and pasting them into the survey when you are ready. Please ensure you have your letters of reference before filling out the application as well.

Question Title

* 1. Name

Question Title

* 3. Phone

Question Title

* 4. Address

Question Title

* 5. Date of Birth

Date

Question Title

* 6. Gender:

Question Title

* 7. Best Time to Contact you by Phone:

Question Title

* 8. Do you have a blood or bleeding disorder?

Question Title

* 9. What blood or bleeding disorder do(es) you or your sibling/parent have?

Question Title

* 10. Do(es) you or your sibling/parent have an inhibitor (active or tolerized)?

Question Title

* 11. My local chapter/association is:

Question Title

* 12. My local Hemophilia Treatment Center (HTC) is:

Question Title

* 13. Current school and/or employer:

Question Title

* 14. To utilize the budget to the best of our ability, the NYLI program uses double occupancy lodging when attending events. This means that you would have one singular roommate at NYLI sanctioned events. Would this be an issue for you?

Activities: Please describe the activities you have been involved in and any achievements over the last four years. Please describe your role and include the dates involved with each one.

Question Title

* 15. School Organizations and/or Athletics:

Question Title

* 16. Awards, Honors, Achievements:

Question Title

* 17. Volunteer Work/Community Service:

Short Essays: Please respond to each of the following short essay questions using a maximum of 350 words for each question. Essays can be written and edited in a word processor and then copied into the text boxes below to ensure the elimination of grammar and spelling mistakes.

*A heavy amount of weight is given to the quality and effort shown in these essays. While each essay should not exceed 350 words, please make sure to fully answer each question as this is your main avenue to present yourself in this competitive application process.*

Question Title

* 18. In your own words, what is NYLI?

Question Title

* 19. Why do you want to be a member of NYLI?

Question Title

* 20. Keeping the goals of NYLI in mind, what do you hope to learn as a NYLI member?

Question Title

* 21. Why do you think it is important to be involved in your community?

Question Title

* 22. Please discuss a past leadership experience and explain how you can use it to benefit the bleeding disorders community.

Question Title

* 23. Give an example of a leader who has influenced you and why.

Question Title

* 24. In your opinion, what are the three (3) most important qualities in a good leader? Which of these qualities do you have?

NYLI Member Expectations & Requirements
NYLI is a pre-professional development program designed to prepare NYLI members for the professional world through learning about and practicing professional behavior. NYLI members are also preparing to become leaders within the bleeding disorders community. Throughout this time, NYLI members are representatives of NBDF and their own local organizations and are expected to behave in a manner which exudes positive leadership and reflects on NBDF in a positive way. NYLI is a two-year
program and requires a two-year commitment once accepted into to the program. Listed below are the time and activity requirements as well as the expectations of behavior for NYLI members. These requirements and expectations are discussed and committed to during the NYLI interview for all potential members, then reexamined during the NYLI 1st year training.

1. NYLI Identity:
a. NYLI is a safe space for authentic identity expression which allows all members to learn and grow in a supportive environment. The following ground rules should be followed and protected by the group.
i. Being respectful, active listening, creating and participating in a learning environment, going out your way to talk to or engage with people who are different or have different life experiences than you, and
treating others the way they would like to be treated.
ii. Any inappropriate or offensive behavior such as, but not limited to, racial, gender, or ethnic slurs or any form of harassment should be reported to NBDF staff and will result in disciplinary action depending on the results of an investigation.

2. Conduct Yourself in a Professional Manner
a. Arrive to NYLI trainings and NYLI facilitated workshops on time, prepared with any required materials, and in appropriate dress. All NYLI trainings and workshops have a dress code of business casual unless otherwise stated.
b. Respect and meet deadlines – i.e. booking flights, submitting evaluations, registering for events, submitting NYLI assignments, etc. Consistent inability to meet deadlines will result in the loss of opportunities. (i.e. not booking a flight before the deadline may result in missing the opportunity to travel to that event). Missing deadlines has financial implications to NBDF and participants must be good stewards of NBDF funds.
i. If you cannot meet a deadline, it is your responsibility to reach
out to the appropriate staff person in advance of the deadline to ask for an extension. Extensions may be granted if financially feasible.
c. Timely response within 24 hours to emails, calls, or texts.
i. If you cannot provide the required information within 24 hours, please respond to the communication within 24 hours asking for an extension.
d. You are expected to follow all applicable laws (i.e., no drug use or
underage drinking). If drug or alcohol use causes harm to yourself or others, you will be immediately dismissed from the program.
e. Keep all relationships on a professional level.

3. Time commitment + Attendance Requirements
Travelling is a major component of the NYLI program. NYLI members are privileged to travel and attend 2-4 in-person trainings annually with their cohort, each lasting 3-6 days. These typically take start on weekdays and end on weekends. Additionally, NYLI members fulfill virtual and in-person requirements including in their specified track - Advocacy, Education, or Research. If an NYLI member plans to miss an in-person training, it is the responsibility of the NYLI member to make alternative arrangements with the NYLI Program Manager. NYLI members should also plan to fulfill track requirements, including completing a capstone project in their second year.
4. Regular Participation with Local Chapter
a. NYLI members are training to become leaders within the bleeding disorders community are encouraged to attend chapter events whenever reasonably possible.
b. At a minimum, NYLI members are required to interview their chapter once a year and identify 2 opportunities to volunteer within that
program year. The interview can take place via phone or video conference if the member lives more than a 1.5 hour drive away from their chapter.
c. One of the two volunteer opportunities per program year (June - May) may take place virtually if the NYLI member and chapter come to that designation together.

Question Title

* 25. By signing my name below, I certify that I have reviewed, understand, and agree to all NYLI Expectations and Requirements.

Conflict of Interest Policy
Each director, officer, employee, and volunteer of the National Bleeding Disorders Foundation (NBDF) has a responsibility to scrupulously avoid any direct or indirect conflict of interest between his or her own personal, professional, or business interests and the interests of NBDF or its subsidiaries and to act in the best interest of NBDF. To this end, each employee and volunteer:
1. Shall avoid any material conflict of interest and any potential conflict of interest, either real or perceived, between the interests of NBDF and the interests of any other entity.
2. Shall exercise the utmost good faith, honesty, care, skill and judgment in every transaction relating to his or her duties to NBDF.
3. Shall not use his/her position, or knowledge gained there, in such a manner as to create a conflict of interest or perceived conflict of interest between the interests of NBDF and his or her personal interests.
4. Shall immediately disclose any potential conflict of interest. (If there is any uncertainty whether a certain transaction, activity, or relationship constitutes a conflict of interest, the individual shall ask the CEO of NBDF for clarification.)
5. Shall keep the interests of NBDF foremost in any dealings involving NBDF.
6. Shall avoid directly or indirectly participating in any discussion, decision, arrangement, investment, vote, or other activity that constitutes a conflict of interest or potential conflict of interest, or that could result in personal benefit to the individual or any member of their immediate family.
7. Shall not accept any favor, gift (other than of token value) or excessive entertainment from any source that may be perceived as influencing or having the potential to influence the performance of his or her duties to NBDF.
8. Shall not conduct personal business with NBDF or its subsidiaries, nor use NBDF assets, employees, information, events or activities for personal use, nor develop a relationship with employees of NBDF that might interfere with the exercise of impartial judgment in decisions affecting NBDF.
9. Shall not obtain any economic benefit for themself, any member of their immediate family, or any other friends or relatives, from their association with NBDF. (This shall not apply to the salary and benefits an employee of NBDF derives from such employment.)
10. Shall immediately offer their resignation if their status changes so that they can no longer comply with the requirements of this policy.
Conflict of Interest Procedures
1. All prospective NYLI members shall complete a Conflict of Interest Disclosure Form for review by the NYLI Manager of NBDF prior to being nominated to NYLI.
2. Each NYLI member shall annually, at the first meeting of the fiscal year, and whenever any relevant change occurs in the member’s situation,
complete a Conflict of Interest Disclosure Form.
3. All prospective volunteers shall complete a Conflict of Interest Disclosure Form for review by the NYLI Manager, prior to an offer of employment being made or, in the case of a volunteer, prior to commencing volunteer activities.
4. Each employee and volunteer shall annually, at the beginning of each fiscal year, and whenever any relevant change occurs in the
employee’s or volunteer’s situation, complete a Conflict of Interest Disclosure Form.
5. Copies of all disclosure forms of NYLI members shall be reviewed by the VP for Education, shall be maintained at the offices of NBDF, and made available to any staff member for review upon request to the VP for
Education.
6. Any possible conflict of interest shall be disclosed to the VP for Education in advance of any discussion or action by NYLI. (Members shall err on the side of prudence and declare any actual as well as potential conflicts of interest.)
7. The minutes of meetings shall reflect any disclosures of
conflicts of interest.
8. The NYLI Manager shall refer to the VP for Education and the CEO who shall have authority to administer and enforce all aspects of the Conflict of Interest Policy.

Question Title

* 26. Conflict of Interest Disclosure

Question Title

* 27. By signing my name below,
I certify that I have read
and understand the Conflict
of Interest Disclosure
Form.

Two (2) Letters of Recommendation
You need two (2) letters of recommendation as a part of this application. Letters should NOT be written by a family member or relative. Once your references submit their recommendation you will be able to see that part of your application is complete.
1. The first letter is a recommendation of you as a professional and should come from your personal or professional circle. Ex: Work Supervisor, Professor, Intern Manager, Youth Group Leader
2. The second letter is a recommendation of you as a member of the bleeding disorders community and should come from someone who knows of your involvement in the community. Ex: Chapter/Association staff, HTC staff, camp director, Lead Volunteer

**If you do not have a reference from within the bleeding disorders community, please email Heather Hicks at hhicks@bleeding.org or call 865-441-2403.

Question Title

* 28. Professional or Personal Reference Name

Question Title

* 29. Professional or Personal Reference Email

Question Title

* 30. What is your relationship to this reference and how long have you known them?

Question Title

* 31. Please upload your letter of reference here.

PDF, DOC, DOCX, PNG, JPG, JPEG file types only.
Choose File

Question Title

* 32. Community Member Reference Name

Question Title

* 33. Community Member Reference Email

Question Title

* 34. What is your relationship to this reference and how long have you known them?

Question Title

* 35. Please upload your letter of reference here.

PDF, DOC, DOCX, PNG, JPG, JPEG file types only.
Choose File

T