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* 1. What is your name?

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* 2. What is your current professional work, if any (please provide your title & organization and/or brief description, as applicable)

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* 3. How and when can we most easily reach you? (Please provide your email and phone number. Please also give us your timezone).

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* 4. What are you seeking right now that makes it important for you to participate in The Shift Leadership Academy?

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* 5. What would you like to see shift and change in yourself and/or your leadership in order to move towards this future possibility? Why is this important and why now?

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* 6. What skills and competencies do you need to develop in order to make this possibility real?

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* 7. How committed are you to doing what it will take to making this program a huge success for you? Please explain.

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* 8. Please describe your professional experience, your current sense of your work purpose/mission, and what will be most important to take it to the next level.

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* 9. What programs and/or practices have been most transformational for you, and how have you grown from them?

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* 10. What signs or synchronous events have occurred recently, or what else is happening that would indicate that this is the right program for you right now?

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* 11. What support structures do you have in your life to ensure that you can successfully complete this program?

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* 12. What do you envision for yourself at the end of this program?

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* 13. Would you like to schedule an interview before registering in the program?

Thank you! After clicking the "done" button below, your application will be submitted.

The next step is that we will reach out to qualified applicants for an interview and coaching call with Shift Leadership Academy faculty and/or Director of Education, Alison Weeks. We hope to support you to step into your next level of leadership!

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* 14. Do you have any questions that you would like to ask us about the program? If so, please list them here: