2024 Emerging Leader Program Application
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1.
Your Name
(Required.)
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2.
Title
(Required.)
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3.
Company
(Required.)
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4.
Mailing Address
(Street, City, State, Zip)
(Required.)
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5.
Email Address
(Required.)
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6.
Work #
(Required.)
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7.
Cell #
(Required.)
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8.
LinkedIn Profile Link
(Required.)
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9.
Supervisor name, title and email
(Who at your company approves your participation in this program?)
(Required.)
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10.
Will your company cover the registration fees as well as travel to up to 4 in-person sessions?
(Required.)
Yes
No
If “No,” please explain.
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11.
What are your primary job functions?
(100 words or less)
(Required.)
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12.
How long have you worked at your current company?
(Required.)
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13.
What are you hoping to get out of the PEMA Emerging Leader Program?
(200 words or less)
(Required.)
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14.
Can you commit to spending time each month? Six formal, live (or virtual) workshops, alternating with virtual roundtable discussions once each month?
(Required.)
Yes
No
If “No,” please explain.