ProInspire Leadership Institute (PLI) Registration
Your Contact Information
Please share your contact information so that we can send you materials (via email and snail mail) and connect you with other program participants.
First Name
Last Name
Primary Mailing Address
City
State
Please select...
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code
Address Type
Please select...
Home
Work
Other
Preferred email
Personal
Work
Other
Work Email
Personal Email
Other Email
Preferred phone
Mobile
Work
Home
Work Phone
Mobile Phone
Home Phone
Age
Please select...
18-24
25-34
35-44
45-54
55-64
65+
I prefer not to answer
Gender
Please select...
Female
Male
Trans Male
Trans Female
Gender Variant/Non-Binary/Non-Conforming
Not Listed (please specify)
I prefer not to share my gender identity
Gender (other)
Race/ethnicity
Please select...
American Indian or Alaskan Native
Arab, Middle Eastern, or North African
Asian or Asian American
Black or African American
Latinx or Hispanic
Multi-racial or Multi-ethnic
Native Hawaiian or Pacific Islander
White or Caucasian
I prefer not to share my racial/ethnic identity.
Not Listed (please specify)
Race/ethnicity (other)
Please select which program you are registering for:
Please select...
October 21-22, 2020
Registration Closed
The session you are trying to register for is
closed
. Please select a different session.
Food Preferences &
Accommodations
Food Preferences / Restrictions
I eat anything
Vegetarian
Vegan
Gluten-Free
Allergy (please specify)
Other (please specify)
Please indicate any food allergies you have in the 'other' field
x
Other Food Allergies & Preferences:
If you require accommodations to participate in the two full-day workshops, please list them below (e.g., access to a wellness room)
We will take group photos during workshops and may use them on social media, our website, or in marketing materials. Do you agree to be included in these images?
Yes
No
Your Work and Experience
Current Employer
Current Job Title
How many years have you been in this role?
Please select...
<1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
>20
Total years of full-time work experience as of today
Please select...
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
>20
What types of responsibilities do you have in your role? (Select all that apply.)
Manage budgets
Manage direct reports
Manage funders
Manage projects
Manage stakeholders
Manage teams
N/A
Have you received any leadership or managerial training since becoming a manager?
Yes
No
Of the following competencies/skills covered as part of the ProInspire Leadership Institute, which are you most interested in developing/would have the greatest impact on your leadership? (Please select all that apply. Scroll down the list to see all options. For multiple selection, hold down Command or Ctrl key.
Please select...
Personal Mission
Emotional Intelligence
Implicit Bias
Trust
Delegation
Coaching
Feedback
Personal Board of Advisors
Your Supervisor's Information
Supervisor's First Name
Supervisor's Last Name
Supervisor's Email
Your Background
The information you provide below will be shared with the other members of your Managing for Success cohort.
LinkedIn Profile Link
Bio (max 200 words)
Please upload a current headshot
This headshot will be included in your cohort's bio file and posted on the ProInspire website.
Use the naming convention: LASTNAMEFIRSTINITIAL.JPG.
Your Payment
Are you able to commit to fully participating in each of the two workshops and completing all program prework/homework
Yes
No
We have limited partial scholarships available to offset program fees for participants whose organizations cannot sponsor them.
Would you like to be considered for a scholarship?
Yes
No
Please upload an essay that answers the following two questions:
1) How much financial support are you seeking?
2) How will this program benefit you? Please keep this at maximum
300 words, and title the file "FirstName_LastName_Scholarship." If you are applying for a scholarship please choose the option to be invoiced while we review your application.
How will your program fee be paid?
Via credit card
Please send an invoice
Discount Code
Please provide the name and email address of the individual who should received the invoice.
Post-Discount Total
Payment Information
Name on Card
Card Number
MM
YY
Code
Please enter the email address where your registration confirmation should be sent
You have reached the end of the application. By submitting you agree to our
ProInspire Leadership Institute terms and conditions
. Are you ready to submit?
Yes, my application is complete.