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Name *

Name

First Name

Last Name

Employer *

Job Title *

Industry *

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Address *

Address

Address 1

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City

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Phone *

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Email Address *

How did you hear about this program? *

Essay Questions

Please answer the following using no more than 750 words per question. In crafting your responses bear in mind the selection criteria and take this as an opportunity to tell us how you fulfill those criteria.

Please describe what you think makes you a good leader. *

Please explains the challenges you are currently facing in one or more of the areas below and how you would like a mentor to help you navigate through them. *

Impact Center Fellows have worked with their mentors to address two key areas of development. Career Development: Looking for help in developing and determining their career pathway overall and how to move to the next level specifically. Professional Development: Facing concrete challenges in their day-to-day professional lives and needing specific skills and strategies to handle them along the way.

What professional achievement are you most proud of? How did you accomplish it? *

How will this Fellowship enable you to make a greater impact on our society? *

Demographic Information

By answering the optional questions below, you will help the Impact Center judge our progress in achieving a breadth of applicants that reflects the diversity of the next generation of women leaders.

Race / Ethnicity

Mark all that apply.

African-American

American Indian/Alaska Native

Asian-American

Bi-Racial/Multi-Racial

Caucasian

Hispanic/Latina

Native Hawaiian/Pacific Islander

Other

Religious Affiliation

Choose one

Are you the first in your family to graduate from college?

First in my family to obtain an undergraduate degree

First in my family to obtain a graduate or professional degree

Not the first in my family to achieve these milestones

Are you a United States military veteran? If yes, please specify the branch and your rank.

Apply to the Executive Leadership Program

Impact Center