Leadership Impact Cohort Application
Cohorts are chosen on a rolling basis through this brief application process. We strive to include participants of similar role or organizational experience in each cohort and blend varying participant demographics and locations. The program meets for 90 minutes every Wednesday at 10 am PST. Upon filling out this application you will automatically be placed on a waiting list for the next cohort. Your fee of $275 will be processed only upon confirmation of your acceptance.
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First Name *
Last Name *
Company *
Title *
Preferred Email Address *
Preferred Phone Number *
If you are applying because of your affiliation with another organization, please note that affiliation and your role (board member, partner, etc.).
Please list the name and organization of anyone else applying with whom you hope to enroll in the same cohort.
What interests you most about this workshop? *
What outcomes are you seeking from this workshop? *
What are your biggest current organizational challenges? *
Which of the classes do you feel are most relevant for you at the moment (select as many as you like)? *
Why did you choose the answer(s) above? (Optional)
Is there anyone else you think would benefit from this program? Please list name, professional affiliation, and email address. (Optional)
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