Application

Name *

First Name

Last Name

Phone *

(###)

###

####

What best describes your current leadership setting? *

Church / Ministry

Business / Marketplace

Education

Nonprofit / Community

Other (please specify)

Are you willing to commit to the full 12-week experience including all sessions and assignments?

Yes

No

The cost of the cohort is $1,200. How do you plan to cover this? *

I will pay in full up front

I need a payment plan

I’d like to apply for a scholarship

Would you like to be considered for a scholarship? *

Yes

No

Please click on both boxes as a sign of commitment. *

I understand the time, financial, and spiritual commitment involved and am ready to grow as a leader.

I certify that the above information is true and complete.

Signature (Typed name) *

First Name

Last Name