Leadership Academy Enrollment Form

Get ready to enhance your leadership skills!

After completing this form you will be enrolled in the Leadership Academy. You will receive a confirmation email within 1-3 days. Upon successful completion of the course you will receive a digital badge credential.

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* Which Leadership Academy do you want to attend?

Madison - 9/12-10/17, Thursday, 8 AM-4 PM

Fort Atkinson - 10/9-12/18, Every other Wednesday, 8 AM-4 PM

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* Student Personal Information

First Name

Last Name

Date of Birth

Email Address

Student ID # (if known)

Phone

Street Address

City

State

Zip

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

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* Confirm your Email Address

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* Name of your current workplace:

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* 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 $325/each for a total of $650. You will receive your bill in the mail.

I understand.

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* Select the ethnicity you most identify with (optional)

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* Gender (optional)

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* 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

I am paying

My employer is paying

Leadership Academy Enrollment Form

Get ready to enhance your leadership skills!

Question Title

* Which Leadership Academy do you want to attend?

Question Title

* Student Personal Information

Question Title

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

Question Title

* Confirm your Email Address

Question Title

* Name of your current workplace:

Question Title

* 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 $325/each for a total of $650. You will receive your bill in the mail.

Question Title

* Select the ethnicity you most identify with (optional)

Question Title

* Gender (optional)

Question Title

* Are you paying for this class or is your employer?If your employer is paying, please have them complete this formThird Party Billing & Enrollment Authorization

* 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