Application Form

Thank you for your interest in the 2024 ImpACT! Leadership Program. 

The 10 month program will take place both virtually and in person between December 2023 and September 2024.

The in-person seminar will take place February 4-6, 2024, at the Anaheim Marriott, in Anaheim, CA. 

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. Are you an ACT member?

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

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

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

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* 9. Which ACT Chapter are you in?

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* 10. Have you participated in other leadership programs through your employer or another provider? E.g., DiSC, Emergenetics, Myers-Brigg, StrengthFinders

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* 11. 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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* 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. Professional Resume

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
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* 15. Do you confirm that, if you are selected, you are able to attend the retreat in February; the International Conference August 4-7,  2024, in Denver, CO; as well as participate in monthly virtual events and group projects?

Thank you for your application. Selected applicants will be notified by the end of August so they can start making travel arrangements.

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