Leadership Circle Application 2016-2017

This application is for the CNM Connect sponsored Leadership Circle program. This program is designed to provide peer coaching support with monthly gatherings of professionals from the nonprofit community. These facilitated sessions meet from September through May, and offer an opportunity for personal growth, peer support and action learning. Applications are required for both new and renewing circle members. Upon acceptance, you will be notified and billed accordingly. The cost of the program is based on your agency's annual operating budget, and whether you are new or renewing.

Budget Size New Renewing

$75,000 to $500,000 $350 $300

Over $500,000 $375 $325

Plan on approximately 10 to 15 minutes to complete the application. Acceptance in the program will be communicated mid-July.

Thank you for your interest in your professional development through this program.

Question Title

* 1. Please fill out your information below.

Your Name:

Current Position:

Organization Name:

Mailing Address:

Work Phone:

Cell/Other Phone:

Fax:

Email:

Years in current position:

Years experience with nonprofits:

Agency Staff Size:

Annual Budget Size:

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* 2. Is your agency currently a CNM member?

Yes

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* 3. Mission of your organization:

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* 4. Areas of service (check all that apply):

Animal Welfare

Civic

Environmental

Social Service

Health

Art/Culture/Humanities

Educational

Religious

Youth Development

Housing

Other

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* 5. Which Circle best describes your position?

Executive Director/CEO

Development Director

Program Director

Marketing Director

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* 6. Are you a renewing participant?

Yes