Apply for Managing for Success

Your Contact Information

Please share your contact information so that we can send you materials (via email and snail mail) and connect you with other program participants.

First Name

Last Name

Primary Mailing Address

City

State

Zip Code

Address Type

Preferred email

PersonalWorkOther

Work Email

Personal Email

Other Email

Preferred phone

MobileWorkHome

Work Phone

Mobile Phone

Home Phone

Date of Birth

Gender

Gender (other)

Race/ethnicity

Race/ethnicity (other)

Food Preferences / Restrictions

Other Food Allergies & Preferences:

If you require accommodations to participate in the three full-day workshops, please list them below (e.g., access to a wellness room)

We will take group photos during workshops and may use them on social media, our website, or in marketing materials. Do you agree to be included in these images?

YesNo

Your Work and Experience

Current Employer

Current Job Title

Total years of full-time work experience as of Jan 2019

How many years have you been a manager?

Have you received any leadership or managerial training since becoming a manager?

YesNo

What is a management skill you want to develop, and why? Please respond in 1-2 sentences.

Your Supervisor's Information

Supervisor's First Name

Supervisor's Last Name

Supervisor's Email

Your Background

The information you provide below will be shared with the other members of your Managing for Success cohort.

LinkedIn Profile Link

Bio (max 200 words)

Please upload a current headshot

This headshot will be included in your cohort's bio file and posted on the ProInspire website. Use the naming convention: LASTNAMEFIRSTINITIAL.JPG.

Your Payment

Are you able to commit to fully participating in each of the three workshops and completing all program prework/homework (approximately 2-3 hrs per month)

YesNo

Who will be paying the registration fee?

My organization will be paying my feeI will be paying the fee myself

We have limited partial scholarships available to offset program fees for participants whose organizations cannot sponsor them.Would you like to be considered for a scholarship?

YesNo

Please upload an essay that answers the following two questions: 1) How much financial support are you seeking? 2) How will this program benefit you? Please keep this at maximum 300 words, and title the file "FirstName_LastName_Scholarship." If you are applying for a scholarship please choose the option to be invoiced while we review your application.

Organization Size

How will your program fee be paid?

Via credit cardPlease send an invoice

Registration Type

Discount Code

Please provide the name and email address of the individual who should received the invoice.

Post-Discount Total

Payment Information

Name on Card

Card Number

MM

YY

Code

Please enter the email address where your registration confirmation should be sent

You have reached the end of the application. By submitting you agree to our Managing for Success terms and conditions. Are you ready to submit?

Yes, my application is complete.

I eat anything	Vegetarian	Vegan
Gluten-Free	Allergy (please specify)	Other (please specify)

Apply for Managing for Success

Managing for Success Registration

Your Payment

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