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CC Leadership Program Application
Thank you for your interest in the Connective Communication Leadership Program. Applications are being accepted through September 20th, 2021. Those accepted into the program will be notified on September 21st, 2021. Please be sure to pay your application fee of $25 after you've submitted your application.
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* Indicates required question
Name
*
Your answer
Email
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Your answer
Phone number
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Please use the format: +(Country Code) and your number
Your answer
City, State
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Your answer
Country
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Your answer
Full Mailing Address
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Before the program starts, we mail out some course materials so we need your regular, snail-mail address, please.
Your answer
Emergency Contact - Name & Relationship (parent, partner, friend, etc.)
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Because this course is virtual, we would like to be able to contact someone who lives close by to you in the rare event of an emergency to contact you.
Your answer
Emergency Contact - Phone Number
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Not your phone number, this is the phone number of your emergency contact. Please use the format: +(Country Code) and their number
Your answer
If accepted into this program do you give permission for your email to be shared with other participants as part of a contact list?
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Yes
No
Are you able to attend the full 4 days of the entire course - 11am to 5pm on October 26, 27, 28, & 29, 2021? Note: Class dates/times are in USA Eastern Standard Time or UTC -5:00.
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Yes
No
Required
What organization/business are you a part of? If not currently associated with one, what's your primary focus/passion?
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Your answer
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