First Name *

Last Name *

Email *

Phone *

Organization *

GNTC membership is required for this program. Is your organization a member of the GNTC? *

Enter required value Yes No; please contact me about joining. I don't know; please contact me if my organization is not a current member

Do you have a disability or impairment requiring accommodations? *

Enter required value Yes No Prefer not to respond

Please list any dietary restrictions or food allergies.

Do you have any prior commitments that would prevent you from attending these scheduled sessions? *

LIST DATES

Are you and your employer willing to make the commitment for you to attend all scheduled sessions? *

This program runs for 3 months, with meetings held on Friday mornings at Tech Hill Commons. Additionally, there is a day-and-a-half kick-off training on August 27th and 28th. 100% attendance is expected. If you are unable to make this commitment, it is not in your best interest to apply at this time.

Enter required value Yes No

Current Title & Responsibilities *

Briefly describe your position with particular attention to leadership, responsibilities, number of people under your supervision, etc.

How long have you been in a role with people management responsibilities? *

Enter required value 0 Years 1-3 Years 4-9 Years 10+ Years

Please provide a link to your LinkedIn Profile *

What professional goals have you set for yourself related to leadership development? *

What are your expectations for this program? *

How did you hear about this program? *

Is there a leader in your organization who is encouraging you to apply to this program? *

Note: this is not a requirement for acceptance

Enter required value Yes No

If no, have you talked with your manager about the time commitment required for this program?

Yes, I have spoken with my manager and they understand the time commitment and are supportive of my involvement No, I have not spoken with my manager

Please provide the name and title of your manager or the leader sponsoring your application.

What is your relation to the person listed above?

Direct Supervisor Other leader in the organization Other

If you selected other in the above field, please describe.

Would your sponsor/manager like to be a mentor for the ELITE program? *

Enter required value Yes No I don't know

Please provide an email address for your sponsor/manager. *

Please provide a phone number for your sponsor/manager.

What other information would you like us to know for consideration? *

If accepted, please acknowledge you agree to pay the program cost of $1,950. *

Enter required value Yes, I agree. No, I cannot commit to paying this fee if selected.