Application Form

Thank you for your interest in the 2022 ImpACT! Leadership Program. 

The program will take place January 23-25, 2022, at the Hilton Orlando Lake Buena Vista, FL, conveniently located next to Disney Springs. 

Please provide the following information, and be sure to upload all the required attachments. 

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* 1. Name

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* 2. Title

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* 3. Organization

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* 4. Contact Information

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* 5. How many years have you worked in the TDM industry?

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* 6. Within your current organization, do you currently have staff reporting to you?

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* 7. If you have staff reporting to you, please share how many.

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* 8. Which ACT Chapter are you in?

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* 9. Have you participated in other leadership programs (in TDM or any other industry)?

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* 10. To help us gauge interest and ensure that our programs are reflective of our membership, please let us know if you consider yourself to be a member of an ethnic, racial, gender, or other diverse identity:

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* 11. Professional Resume

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

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* 12. Personal Narrative

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
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* 13. Reference Letter

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
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* 14. Commitment Form

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

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* 15. Do you confirm that, if you are selected, you are able to attend the retreat in January; the International Conference July 31-August 3, 2022, in Chicago, IL; as well as participate in pre- and post-virtual events and group projects?

Thank you for your application. Selected applicants will be notified as soon as possible in the Fall so they can start making travel arrangements.

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