Leadership Academy Enrollment Form Survey

Which Leadership Academy do you want to attend?(Required.)

Fort Atkinson Campus 2/11/26-4/11/26 Every other Wednesday 8AM - 4PM

Reedsburg Campus 3/24/26-4/28/26 Tuesday 8AM-4PM

Student Personal Information
(If student ID is unknown, enter N/A)(Required.)

First Name

Last Name

Date of Birth

Email Address

Student ID # (if known)

Phone

Street Address

City

State

Zip

Confirm your Email Address(Required.)

Please list any former names (this helps if you already have an account in the system).

Name of your current workplace:

By filling out this form you are agreeing to be billed and pay for Leadership Development Academy. Please note your bill will state "Leadership Academy" and "Leadership Academy part 2" for $375
each for a total of $750. You will receive your bill in the mail. (Required.)

I understand.

Select the ethnicity you most identify with (optional)

Gender (optional)

Are you paying for this class or is your employer?
If your employer is paying, please have them complete this form
Third Party Billing & Enrollment Authorization(Required.)

I am paying

My employer is paying

Leadership Academy Enrollment Form

Get ready to enhance your leadership skills!