Program Name
Program Dates
Program Location
First Name
*
Last Name
*
Position Title
*
Job title
Organization Name
*
The name of your organization
Length of Time in Current Position
*
Less than 1 year
1 year to 5 years
6 years to 10 years
11 years to 20 years
More than 20 years
Email
*
Your email address
Re-enter Email
Your email address
Best Contact Number
*
A number where we can reach you about this application
Street Address (No PO Box)
*
Your organization's address
City
*
State/Province
*
ZIP/Postal Code
*
Country
*
Assistant Name
If we will be contacting you through your assistant
Assistant Phone
If we will be contacting you through your assistant
Assistant Email
If we will be contacting you through your assistant
Learning & Development (L&D) Point of Contact Name
Please provide your Organization's L&D Point of Contact Name
L&D Point of Contact Phone Number
(Please do not use hyphens)
L&D Point of Contact Email
Total Number of Employees in Your Organization
*
Budget You Manage
*
Total Years of Experience Leading Others. Briefly Describe.
*
Total Years of International Experience. Briefly Describe.
*
Title of Person to Whom You Report
*
Describe Your Role in the Organization
*
Choose from value list
C-Suite or Executive Team Member
C-1 (SVP or EVP Level)
C-2 (VP or GM Level)
C-3 (Executive Director or Equivalent)
Other
How Many Individuals Report to You Directly?
*
Direct Reports
How Many Individuals Report to You Indirectly?
*
Those who report to you indirectly.
Describe your Primary Accountabilities in the Organization
*
What Are You Hoping to Gain from Completing this Program?
*
How Did You Learn About This Program?
*
Please Provide Professional Social Media Profile Links you may wish to include (e.g. LinkedIn).
If You Did Not Provide a LinkedIn Profile, Please Attach a Copy of Your CV
You can upload doc, docx, pdf and xls file types
CCL’s Cancel/Transfer policy http://www.ccl.org/cancellation-policy
*
Upon submission, I acknowledge I have read and understand CCL’s Cancel/Transfer policy.
Yes