FPLP Nominee Application

Nominee 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 *

Years in current position *

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

LinkedIn Profile Url *

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

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

Please describe your level of influence in your current organization? For example, where and how do you have the ability to impact change? *

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. *

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? *

Live sessions are generally scheduled the second Friday of the month* at 9 am Pacific Time
Peer Practicums generally occur the 4th Thursday or Friday of the month*, depending on what group you are placed in. (*please see the course calendar for full list of dates).

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

Do you require tuition assistance? In no, press submit to complete enrollment. If yes, please answer the remaining questions and then press submit. *

No Yes

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 email 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 (like free bonus workshops). *

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

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