The Leadership Advantage: Program Application

Deadline to submit program applications is September 21, 2012.

A paper application is available within our pdf brochure. If you wish to complete the paper version instead of the online application, you can fax it to CMA at (314) 721-1992, email to kreed@cmaconsult.com, or mail to:

CMA

c/o The Leadership Advantage

7751 Carondelet Ave., Ste. 302

St. Louis, MO 63105

Contact Information

Program Participant

Full Name: *

Organization: *

Prefix:

Position/Title: *

Email: *

Phone: *

Mailing Address Line 1: *

Mailing Address Line 2:

City, State, Zip: *

Direct Reports (#): *

Organization Tenure (years): *

Management Tenure (years): *

Executive Sponsor

Sponsor's Preferred Name: *

Email: *

Phone:

Mailing Address Line 1:

Mailing Address Line 2:

City, State, Zip:

Billing Information

Billing Contact's Name: *

Mailing Address Line 1: *

Mailing Address Line 2:

City, State, Zip: *

Phone: *

Additional Information

1. What has been your proudest accomplishment as a leader? What made this experience so rewarding?: *

2. What has been your most challenging experience as a leader? What did you learn from this experience?: *

3a. We all have strengths and areas we can improve. What 2-3 personal qualities/characteristics do you consider to be most advantageous to your role as a leader?: *

3b. What 2-3 areas could you improve to enhance your effectiveness as a leader? What is holding you back?: *

4. What do you expect to gain by participating in The Leadership Advantage program?: *

5. What, if any, previous leadership and management training have you completed?: *

Certification of Eligibility

I am available on the following dates and times: (1) Friday, October 12, 12:00pm-1:00pm, for a program kickoff lunch and information meeting, (2) Monday, January 21 (arriving at 7:00am) to Wednesday, January 23, 2013 (departing at 5:00pm) for a three-day overnight retreat to be held at the Charles F. Knight Executive Education Center, Washington University in St. Louis, and (3) Monday, April 30, 2013, from 1:00pm-7:00pm for the Action Learning Project presentation and graduation banquet.

YesNo

I have acquired the sponsorship of an executive/senior leader in the organization who has agreed to: (1) attend a program kickoff lunch and informational meeting on Friday, October 12 from 12:00pm-1:00pm, (2) provide input and direction on my Action Learning Project, and support me throughout the program, and (3) attend my Action Learning Project Presentation and graduation ceremony on Monday, April 30, 2013 from 1:00pm-7:00pm.

YesNo

I have read and understand the Components and Program Requirements, and I agree to fully comply with these requirements.

YesNo

I acknowledge that by submitting this program application I am consenting to be immediately invoiced for the full program fee ($7,950), payable within 30 days of invoice.*

*Cancellation policy: Cancellations made on or before October 12, 2012 will incur no cancellation fee. Cancellations made after October 12, 2012 will be subject to a cancellation fee equal to 100% of the total program fee.

YesNo

I understand that this program is subject to cancellation if minimum enrollment is not met by the registration deadline, and that if the program is canceled, I will not be invoiced and I will have the option to rollover my application to be considered for the next available class.

YesNo

Statement of Authenticity

By checking Yes below, I (Program Participant) certify that all information contained in this application is accurate and complete to the best of my knowledge and that the executive sponsor has approved my participation in the program.

I agree: *

YesNo

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Contact Information

Additional Information

Certification of Eligibility

Statement of Authenticity