The Reset Leadership Application Form
Contact Information
Name:
Phone Number:
Personal Email Address:
Home Address:
Work Address (If different from home address):
Work Phone Number:
Work Email Address:
Date of Birth:
Ethnicity:
Employment Information
Do you work for a nonprofit organization or for a profit company?
Nonprofit Organization
For-Profit Company:
Employer Name / Company:
Position / Title:
Approximate Size of Company:
Number of Years at Current Position:
Current Industry:
Number of Years Worked in this Industry:
Do you lead people in your current position:
Yes
No
If applicable, how many years of leadership experience do you have:
Additional Information
Are you seeking financial assistance to participate in this leadership training?:
Yes
No
How
did you hear about the leadership program:
If you were referred to apply by someone, please enter their name below:
Please share a link to your LinkedIn profile:
Please upload your resume below:
Upload your most current professional headshot:
Have you participated in other leadership program(s):
Yes
No
If you selected "yes" above, please tell us about your experience:
Describe what you hope to gain from completing this program:
From a leadership perspective, what is one skill you are looking to build and why:
What is your long-term goal:
Program Requirements
If selected, I am available to attend the required in-person program orientation session on April 12, 2025.
If selected, I understand a non-refundable tuition fee of
$1,499
is due upon acceptance and must be paid prior to the first session. Due to the demand for the program, I understand that my seat may be forfeited and given to another candidate if the tuition fee is not paid by the deadline. If financial assistance is required, we will notify you of full or partial scholarship forgiveness in advance.
If your company will be financially supporting your participation in this program please click here to let us know. (corporate sponsorship not required)
If selected, I agree to abide by the terms and conditions of the program. I understand the time commitments and financial requirements to participate and graduate.
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Contact Information