Please fill this application out in its entirety so that we can get to know you better.

Filling out this application does not guarantee acceptance into the program, nor does it obligate you to register.

Submit your application to join our July cohort, and join The Liberated Leader Retreat for FREE!
When? January 2022. Where? The Dominican Republic.
Questions? Book a call with Grace, our Head of Enrollment, for details!
 

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* 1. First Name

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* 2. Last Name

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* 3. Email Address

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* 4. What is your racial identity? You can choose multiple options. (We ask questions about age, race, and gender in order to help us understand the diversity of our audience and hold us accountable to equitable practices.)

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* 5. What is your gender?

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* 6. What is your age range?

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* 7. Relevant Social Media Handles (instagram, facebook, twitter)

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* 8. What best describes your position? Select all that apply.

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* 9. Please list any programs you’ve taken or are currently taking with Trudi Lebron Coaching/ ScriptFlip! llc

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* 10. How much previous experience do you have with justice, diversity, equity, inclusion and anti-racist practice?

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* 11. What are your challenges related to justice, diversity, equity, inclusion and anti-racist practices?

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* 12. Do you have any professional certifications in coaching or leadership?

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* 13. Did you attend an Institute Open House?

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* 14. What program(s) are you applying to:

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* 15. What start date are you applying for:

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* 16. Would you like to request a call with our enrollment team before you finalize your decision to enroll? (based on your application we may request a call with you before finalizing your enrollment).

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