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Leadership Institute Beta Application

Apply to be part of my Beta Test of the Leadership Institute. The value of the program is over $6,000. There will be a nominal fee of $175 to help me cover my technical costs. You won't get this level of value anywhere else!

Click the button below to start your application. I suggest writing your answers in a separate document first before including in the application in case you get interrupted. 

Start

Question 1 of 6

What does taking your leadership to the next level mean to you? What would that look like in your work?

Question 2 of 6

Why do you want to be part of the beta program for the Leadership Insitute?

Question 3 of 6

What is your title?

A

CEO

B

COO

C

Human Resources

D

Administrator

E

Nurse Leader

F

CFO

G

Executive Director

H

Other

Question 4 of 6

How many hours are you able to devote to this program?

(Select all that apply)
A

1 hour/month

B

3 hours/month

C

5 hours/month

D

10+ hours/month

Question 5 of 6

Please read the following and indicate if you are still interested in being part of the program.

This is my beta leadership program which has been shortened from 1 year. You will spend 5-8 hours a month in courses, implementation, group coaching, and providing feedback. You will also be asked to provide a testimonial for certain areas of the program.

Are you willing to spend the time necessary to make this a great experience for future students?

A

Yes

B

No

C

Not right now, but contact me when your year-long program goes live.

Question 6 of 6

Do you agree to the following if you are chosen for the program?

- Pay $300

- Provide feedback and input to make the program better?

- Have your professional picture, name, and title displayed on any testimonials for marketing purposes?

- Participate as fully as possible in the program and watch replays of training if you aren't able to make them live?

- make a video testimonial of your experience for marketing purposes?

A

Yes

B

No

Confirm and Submit