Climate Champion Scholarship

Application-Full Potential Leadership Program

* Indicates required field

Name *

First

Last

Preferred Mailing Address *

Line 1

Line 2

City

State

Zip Code

Country

Mobile Phone Number *

Work Phone Number *

Preferred Email *

Title *

Organization *

Organization Annual Budget *

Years in current position *

LinkedIn Profile Url *

Years in leadership positions (director-level or equivalent and above) *

Describe your level of influence in your organization? Where and how do you have the ability to impact change? *

Please describe your commitment to working toward climate change solutions *

What do you most hope to gain from this program? *

What are your greatest challenges as a leader? Greatest strengths? *

We strive to create a safe, caring community that also values direct yet compassionate feedback. Please tell us how this aligns with who you are as a leader. *

What would your co-workers say are your greatest contributions as a colleague and leader? Do you agree with them? *

What would your co-workers say are your greatest deficits? Do you agree with them? *

This program is an investment and commitment to yourself, but also to the peers you will be learning with. We understand that during an 8-month span everyone will have challenges and may need to miss a class or two. What will you do to ensure you can be present and prepared for live sessions as much as possible? In other words, can we count on you to be a live and engaged participant? *

Group seminars are generally scheduled the first Friday of the month* at 9 am Pacific Time.
Peer Practicums generally occur the 3rd Thursday or Friday of the month*, depending on what group you are placed in. (*please refer to the course calendar for the complete list of dates).

Though we cannot guarantee your first choice, please let us know which Learning Group time slot you prefer:

Would you like to be considered for the Climate Champion Full Scholarship? If no, press submit to complete enrollment. If yes, please answer the remaining questions and then press submit. *

No Yes

Which best describes your current situation? *

I would not be able to participate without the full scholarship I would be able to participate if awarded a partial scholarship

Which best describes your annual compensation (salary plus bonuses)? *

Below 75k 75k-100k Above 100k

We encourage all participants to engage in a discussion with their employers about their participation in this program and their employer's willingness to financially support their professional development. Which best describes your situation? *

My employer is willing to share the cost of the program if I receive a scholarship My employer is willing to share the cost regardless, but I personally need the scholarship to fulfill my financial part My employer is not willing to pay anything at this time This does not apply to me (I am self-employed, an entrepreneur, about to leave my current employer, etc)

One last thing before you submit...if you are not already part of our email list, would you like to be? You will receive two emails a month with highly curated material geared at inspiring your best leadership. Every once in a while you may receive a couple more emails if we have something special and time-sensitive happening. *

Yes No I'm already on the email list :)

Submit