Mid-Level Leadership Development Application

Please fill out the entire application below. All applications must be received by Midnight PST Friday December 2, 2022. Applicants will be notified of acceptance status by December 9, 2022 and payment (full/monthly) will then be required.

Name(required)

Email(required)

Phone(required)

Organization(required)

Job Title(required)

Years in the Industry(required)

Why are you interested in the Mid-Level Leadership Development course?(required)

What impact do you want to have within your organization?(required)

What impact do you want to have within your community/Industry?(required)

What does leadership mean to you?(required)

Why should we select you to be a part of the 2023 Mid-Level Leadership cohort?(required)

Other Comments

You must check each box or your application will not be accepted(required)

I understand that this is a year long course and I commit to participating fully I have access to computer with internet, zoom platform, camera and microphone If accepted, I agree to pay either a single payment of $1,384 USD or 12 monthly payments of $120 USD

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