The Heart of Leadership

THE HEART OF LEADERSHIP - APPLICATION FORM

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Name *

First

Last

Address *

Email *

Phone Number *

Birthdate *

How did you hear about the Ecology of Leadership? *

What is calling you to join the Heart of Leadership course at this time? What do you hope to gain from participating? *

How are you currently serving in the world? Where are you engaging your leadership? *

Do you currently serve an organization? If so, which, and what is your role? Please provide a website if there is one. *

What is going really well in your life and leadership right now? *

Where are you experiencing the greatest challenges? What are you looking for support to develop and grow at this time? *

What passions, interests, and gifts do you bring? *

Are there any conditions or personal needs that you feel are important for the facilitators to know about, or current life circumstances that might prevent you from fully participating in the program? Please include any psychiatric conditions, medical conditions, or emotional or chemical imbalances for which you have been diagnosed, and if so how you are being supported in working with this (e.g. therapy, medication, exercise, etc.). We will hold this confidential. *

Are you able to attend all 6 weekend sessions including evening programming? *

Each weekend starts at 9am on Friday and ends at 5pm on Sunday. Participants are expected to stay on site for the entire weekend, and to participate fully in all 3 days. In between sessions, you will be given assignments that may take around 6-10 hours of time each month. Can you foresee any challenges meeting these requirements? *

Please share any ways in which you identify that you would like us to know about ahead of your participation (e.g. preferred pronouns, gender identity, orientation, nationality, race/ethnicity, culture, religious affiliation, or any other identities which are important to you). *

Do you feel willing and able to fully commit to the program if admitted? If not, please describe what is in the way of that. *

To secure your place in the circle, please complete your registration now. Please note that if we have any concerns about whether this program is a good fit given your responses, we will contact you. In the unlikely event that we feel unable to serve you, a full refund will be issued.

SUBMIT AND COMPLETE REGISTRATION

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THE HEART OF LEADERSHIP - APPLICATION FORM