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* 1. Please confirm the following before proceeding:

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* 2. First Name

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* 3. Last Name

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* 4. Contact email

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* 5. Contact email of assistant, if applicable

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* 6. Contact phone number (emergencies only)

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* 7. At what institution do you work?

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* 8. Department(s)

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* 9. How many years have you been at your institution?

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* 10. Number of years at Associate Professor Rank
(must be less than 3 years as of the effective date of your promotion)

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* 11. Current leadership positions, if applicable:

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* 12. List three five-year career goals:

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* 13. In your work with groups or teams, what are three attributes that make you effective?

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* 14. In five or fewer sentences, what do you want to learn from this experience? What would you need to develop within yourself to be a more effective leader?

By submitting this application, you attest that you are willing to:

1. Invest in yourself by attending the six webinars (some sessions may be wholly or partially recorded with presenter and participants permission).

2. Participate in six 90-minute group coaching sessions. The presence of all members of the group is critical to group coaching sessions to maximize learning. Scheduling of the groups will be done by the participants and group coach facilitators to maximize attendance.

3. Pay $800 tuition for the six month program by December 31, 2025.

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* 15. Please upload your current CV or resume.
As a reminder, our program is completely confidential and we will never share your information without your consent.

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