Leadership Academy Application 2018
*Note: Class size is limited to 12 participants. The 2017 class is FULL. Apply today to receive priority consideration for 2018 in this systematic 12-month leadership program with coaching, mentoring, and curricula. All sessions are held at Gabrielle Consulting's Leadership Development Center, 3035 Eliza Road, Tallahassee, Florida
Personal Information and Demographics
Name:
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Email address:
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Date of birth:
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Gender
Street Address:
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City:
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State:
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ZIP Code:
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Highest level of education earned:
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Ethnicity:
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Disability and accommodations needed?
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Employment Information
Occupation:
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Years of employment in your profession:
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Current employer name and location:
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What are your aspirations for the future?
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If money were no object, what would you do with your time?
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Please copy and paste your resume or CV:
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Describe any leadership roles you have held.
Describe your experience with mentoring and coaching (giving and receiving):
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What are your leadership strengths?
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What areas of leadership do you need the most improvement?
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Do you consider yourself an emerging leader or a seasoned leader? Why?
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Activities, Awards, and Community Involvement
What awards have you earned?
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List your favorite activities:
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What community involvement or volunteer activity makes you most proud and why?
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What do you like most about living in our community?
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What are the three biggest challenges facing our community today? What do you think should be done about at least one of these challenges?
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References and Referrals
Please list three (3) references (contact information, how long known, relationship to applicant):
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How did you hear about the Leadership Academy?
If you were referred, please share the name of the person who told you about the Leadership Academy.
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Commitment
I commit to the program in its entirety and agree to actively participate in the discussions and engage in feedback geared toward developing fellow participants' leadership skills as well as my own.
Registration and Payment Information
I am registering as:
Required
Emerging Leader Investment - $1,998
Seasoned Leader Investment - $2,498
Includes two additional 90-minute one-on-one coaching sessions with Dr. Gabrielli valued at $1000.
Early Registration BONUSES
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