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* 1. Name

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* 2. Job title, company/non profit and division/department

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* 3. Your email address and phone number

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* 4. Is there a specific job, promotion or raise that you are trying to obtain? If so, please describe:

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* 5. What is your ultimate career goal and why?

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* 6. If you could achieve that goal, how much would it be worth in dollars and any other measure of value to you?

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* 7. What types of professional development tools/programs/people are you currently using or have tried in the past? Did they work? Why or why not?

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* 8. We do not work with everyone. It needs to be a great fit for you, for me and the group - we want to ensure that everyone will benefit from working together. Tell me a little about your personality & what do you can bring to the program?

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* 9. If your application meets the program admissions criteria, you will be emailed to arrange a phone interview.  We respect your time and hope you will respect our's as well. Please CONFIRM your interest and intention to continue the application process in a timely and complete manner by typing your initials in the box below:

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* 10. Finally, on a scale of 1 to Lady Gaga, how confident are you?

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