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Section 1: Organization Information
Organization Name
*
Organization Website (if applicable)
Organization Address
*
Organization Mission Statement
*
Primary Contact Name and Title
*
Primary Contact Email
*
Primary Contact Phone Number
*
Section 2: Eligibility & Impact
How does your organization serve underserved communities?
*
How many employees does your organization have?
*
What are your organization’s top leadership challenges right now?
*
How do you hope this program will support your organization and community impact?
*
Section 3: Participant Information
How many employees would you like to enroll (up to 4)?
*
List employee names and how long they have been with the organization.
*
Briefly share each employee’s leadership goals.
Section 4: Commitment
This program includes three 1:1 coaching sessions per participant and monthly group calls. Can your employees commit to attending?
*
Yes
No
What support will your leadership team provide to ensure participants can fully engage?
*
Section 5: Additional Information
How did you hear about this program?
*
Anything else you’d like us to know about your organization’s leadership development needs?
*
Submit
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