High Potential Diverse Leaders 2019 – Application

Thank you for your interest in the 2019 High Potential Diverse Leaders (HPDL) program. We look forward to reviewing your application. The application deadline is Thursday, August 15, 2019.

Application Instructions
- Answer all questions and (electronically) sign the application.
- Provide resume and one-paragraph bio shortly after online submission to nu@gcn.org, using "HPDL 2019 - [Your First & Last Name]" in the subject line.

Selection Process
- All applications are carefully reviewed by an internal selection committee.
- Receipt of applications will be acknowledged within five (5) business days of the submission of a completed application (this webform) and resume and bio (separate e-mail).
- Payment in full is due before the first session.
- Participation in HPDL is space-limited. Once the class is full, additional applicants will be added to a waitlist and, if no space once the program starts, invited to apply for the next year.

Tuition
- Tuition is $499.00 for GCN members, $699.00 non-members
- Payment in full is due upon acceptance into the program and may be made by check or credit card.

Question Title

* 1. Personal Information

First Name:

Last Name:

Preferred Name to Be Called:

Organization:

Title:

Email Address:

Confirm Email Address:

Phone (123-456-7890):

Years at Current Organization (round to nearest six months):

The following two questions ask about race/ethnicity and gender. We appreciate your consideration in responding to these questions. You are not required to directly answer either question, and your response (including a response of Prefer not to answer) will not be used as a factor in determining eligibility for or acceptance into the program.

We ask these questions to help us understand how well we are making our programs available to the diversity of nonprofit organizations and professionals, as well as to report on our work toward these goals to external stakeholders, including funders.

Question Title

* 2. Which race/ethnicity best describes you? (Please choose only one.)

Prefer not to answer

American Indian or Alaskan Native

Asian / Pacific Islander

Black or African American

Hispanic

White / Caucasian

Multiple ethnicity / Other (please specify)

Question Title

* 3. What is your gender?

Prefer not to answer

Gender:

Question Title

* 4. Organizational Information

Mailing Address:

Mailing Address 2 (if needed)

City:

State:

Zip:

County where organization is located:

Counties served by organization:

Mission:

Annual Operating Budget:

Number of Employees (FTE):

Federal EIN:

Question Title

* 5. How did you hear about HPDL?

Past program participant

My employer

GCN marketing email

GCN website

GCN social media

YNPN Atlanta

Other (please specify)

Question Title

* 6. Have you applied for HPDL before?

Yes (please share which year)

Question Title

* 7. Have you participated in other leadership programs in the past?

Yes (please share which)

Question Title

* 8. Professional Affiliations, and Civic/Volunteer Activities

Organization 1

Position(s) Held

Date(s) of Service

Organization 2

Position(s) Held

Date(s) of Service

Organization 3

Position(s) Held

Date(s) of Service

Question Title

* 9. What do you consider to be your highest professional achievement to date?

Question Title

* 10. Awards and Honors

Organization 1

Award(s) Received

Year(s) Received

Organization 2

Award(s) Received

Year(s) Received

Organization 3

Award(s) Received

Year(s) Received

Question Title

* 11. How will you and your organization will benefit from your participation in HPDL 2019?

Question Title

* 12. Application Completion:

(Electronic) SIGNATURE OF APPLICANT:

Date:

Please remember to submit a resume and one-paragraph bio to nu@gcn.org
using "HPDL 2019 - [Your First & Last Name]" in the subject line.