Screen Reader Mode Icon Check SCREEN READER MODE to make this survey compatible with screen readers. C-Level Program 2023 (Spring) - Application Form For any questions or concerns, please contact Martina Klepalova, EWoB Program Manager (firstname.lastname@example.org) Questions/fields marked with a (*) are mandatory. OK Question Title * 1. Name of applicant: OK Question Title * 2. Surname of applicant: OK Question Title * 3. Academic title: OK Question Title * 4. E-mail address (we prefer a private e-mail as your employer might have spam filters to external accesses or you might change your job):This email address will be used by EWoB Communication team to reach you out with webinar invites and other relevant informations.Furthermore, EWOB is using Google Classroom platform as common space for sharing information, documentation and assignments during CLP. OK Question Title * 5. Phone: (with country prefix +) OK Question Title * 6. Country of residence: Austria Belgium Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Ireland Italy Ireland Lithuania Luxembourg Malta Netherlands Norway Poland Portugal Romania Slovakia Slovenia Spain Sweden Switzerland United Kingdom Other (please specify) OK Question Title * 7. Current employer: OK Question Title * 8. Industry: Aerospace Agriculture Automotive Banking Chemical industry Construction Defense industry Distribution Education Energy & Utility Government Health care Industrial production Information technology Insurance Media Oil & Gas Pharma Retail Telco Tourism & Leisure Other (please specify) Other (please specify) OK Question Title * 9. Size of the company (Yearly turnover in EU market): 15-50 Mio. Eur 50-100 Mio. Eur 100-250 Mio. Eur 250 - 1 bln. EUR more > 1bln. EUR OK Question Title * 10. Name of current position held: OK Question Title * 11. Department within organisation: OK Question Title * 12. Key expertise (fill in 20 key words to define field of expertise)This information will be published for CLP participants in networking brochure. OK Question Title * 13. What is the biggest challenge you are facing currently in your business? (up to 10 words)This information will be published for CLP participants in networking brochure. OK Question Title * 14. What is your hobby or special interest? (up to 6 key words). This information will be published for CLP participants in networking brochure. OK Question Title * 15. Professional aspiration in 1 year time: OK Question Title * 16. Professional aspiration in 5 years time: OK Question Title * 17. Are you part of (any) company board: Yes No OK Question Title * 18. Are you interested to become a board member: Yes No OK Question Title * 19. In which timeframe are you interested in a board position? 1 year 2 year 3 year 4 year +5 year OK Question Title * 20. Attached LinkedIn profile (in English): PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only. Choose File Choose File No file chosen Remove File Attached LinkedIn profile (in English): OK Question Title * 21. Attached a Motivation letter why you would like attend C-Level Program (recommended up to 500 words): PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only. Choose File Choose File No file chosen Remove File Attached a Motivation letter why you would like attend C-Level Program (recommended up to 500 words): OK Question Title * 22. Recommendation letter (this is not mandatory document for application; recommended up to 300 words) PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only. Choose File Choose File No file chosen Remove File Recommendation letter (this is not mandatory document for application; recommended up to 300 words) OK Question Title * 23. Attach your picture (coloured head/shoulders picture which will be shared in the networking brochure and our LinkedIn group):Please, note, if no picture will be shared with us, we use your public LinkedIn profile picture. PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only. Choose File Choose File No file chosen Remove File Attach your picture (coloured head/shoulders picture which will be shared in the networking brochure and our LinkedIn group):Please, note, if no picture will be shared with us, we use your public LinkedIn profile picture. OK GDPR disclaimer: OK Question Title * 24. Your personal data that you provide to us will be protected according to the law on electronic communication (Nr. 127/2005), as well as the law on protection of personal data (Nr. 101/2000), including all amendments. We commit to use it with your knowledge and permission only for the purpose of EWoB C-Level Program. I agree OK Question Title * 25. I agree communication with me will be solely via electronic communication (e-mail). We recommend to use your private e-mail address. I agree OK Question Title * 26. EWoB C-Level Program GROUP CONSENTCLP is not about education, it is about networking. You will meet 40 businesswomen from more than 10 countries. To allow smooth networking, EWoB plans to share following information from your application among CLP participants, EWoB facilitators and CLP speakers: your picture name/surname email contact country of origin current employer & position key expertise business challenge hobby Before CLP kick-off a Networking brochure will be shared among the group. I agree You can leave us a comment: OK Question Title * 27. During C-Level Program 2023 we may capture and share still images (photograph), moving images (video), audio recording, interview statements or other related material in which your identity and/or name may be displayed. This can occur for promotion purposes in social media or through print, digital and electronic means and future audit purposes from our or partners organisations, incl. European Union.During the CLP each participant will work on own video statement, which might be used by EWoB in the future. Before any public launch of individual video, you will retain the right for authorisation.The webinars are being recorded for internal purposes. In case participant is missing and has excused in advance, recording will be share with her.Therefore we seek following consent from you:EWOB RECORDING CONSENTWithout expectation of compensation or other remuneration, now or in the future, I hereby give my consent to European Women on Boards, its affiliates and agents, to capture and share:still images (photographs);moving images (film/video);audio recordings;interview statements;other related material used for EWoB promotion purposes and other media activities related to EWoB's mission in which my name and/or identity may be displayed. I accept that the subsequent use may be in a number of media, including but not limited to print, digital and electronic use by the EWoB and/or by agents authorized by the EWoB.You can call off your consent any time by sending a request to: email@example.com I agree You can leave as a comment here: OK Personal disclaimer: OK Question Title * 28. I agree with dates and my attendance in online C-Level Program.Dates & times (CET):CLP Kickoff: TUE 14.2.2023; 6-8pmWebinar 1: THU 16.2.2023; 9-12am Webinar 2: THU 2.3.2023; 9-12amMeet & Greet: TUE 7.3.2023; 6-7pm (informal networking event)Webinar 3: THU 16.3.2023; 9-12am Webinar 4: THU 30.3.2023; 9-12am Webinar 5: THU 13.4.2023; 9-12am Webinar 6: THU 27.4.2023; 9-12amWebinar 7: THU 11.05.2023; 9-12am Close-out: WED 18.05.2023; 6-8pm (face to face or online)All CLP events are delivered via ZOOM meetings, excepts Close out. Close out is subject of participants choice (EWOB will organise hybrid venue). There are different assignments during CLP duration therefore we'll require your attendance and active participation. I agree OK Question Title * 29. I agree with my financial contribution to C-Level Program: 1.100 EUR (w/o VAT)Price includes 1 year EWoB individual membership fee.Existing EWoB members enjoy 10% discount from the Price applied during payment. I agree You can leave us a comment: OK Question Title * 30. How did you find out about C-Level Program? EWoB newsletter Recommendation from C-Level Program alumni Local EWoB partner association Social media Other (please specify) OK SUBMIT MY APPLICATION. EWOB WILL INFORM YOU SOON.