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.
Primary Mailing Address
I prefer not to answer
Not Listed (please specify)
I prefer not to share my gender identity
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)
Please select which program you are registering for:
October 23-24, 2019
Food Preferences / Restrictions
I eat anything
Allergy (please specify)
Other (please specify)
Please indicate any food allergies you have in the 'other' field
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?
Your Work and Experience
Current Job Title
How many years have you been in this role?
Total years of full-time work experience as of today
What types of responsibilities do you have in your role? (Select all that apply.)
Manage direct reports
Have you received any leadership or managerial training since becoming a manager?
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.
Personal Board of Advisors
Your Supervisor's Information
Supervisor's First Name
Supervisor's Last Name
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.
Are you able to commit to fully participating in each of the two workshops and completing all program prework/homework
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?
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
Please provide the name and email address of the individual who should received the invoice.
Name on Card
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.