2026 BLDP Confidential Business Reference Form

2026 Cohort Black Leadership Development Program Confidential Business Reference Form

Updated 27 November 2025
The Parity Inc. Black Leadership Development Program

907 W. Fifth St. Dayton, OH 45402

Direct questions regarding the Black Leadership Program application process to Carmelia Osley at 937.818.2241 (c)

Direct questions regarding the Black Leadership Program to Sean Walton Sr. at 937.313.8044 (c)

Please complete and submit this electronic Confidential Business Reference Form by 4:30 p.m, December 26, 2025 on behalf of the applicant stated below.
Applicants Name*

First NameLast Name
CONFIDENTIAL BUSINESS REFERENCE FORM

To be completed by the Business
Reference Name*

First NameLast Name
Company or Organization *
Position or Title
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone*
Please enter a valid phone number.
Below please provide information regarding the above applicant. Your responses should indicate your relationship or association with the applicant, the leadership role(s) the person has held or holds, the applicants strengths and weaknesses you have observed in leadership situations, and what benefits you feel the applicant will receive from this program. Your participation in our selection process is greatly appreciated.
Please type your response in the space provided
Name*

First NameLast Name
Date*

MonthDayYear
Date
Please complete and submit this electronic Confidential Business Reference Form by 4:30 p.m. Wednesday, December 26, 2025 on behalf of the applicant stated below.

Questions please call Sean Walton Sr. at (937) 313.8044.
Should be Empty:

2026 Cohort Black Leadership Development Program Confidential Business Reference Form