Momentum Upward Program 2020 Application

Momentum’s Upward Program is designed to provide leadership training, networking opportunities, and mentoring to emerging women leaders for the purpose of enhancing professional development and community leadership.

Please complete this application with written responses as requested below and attach a copy of your resume along with two letters of reference. Email all four documents by August 30, 2019 to:

application@momentumleaders.org

General Information

Name:

Address (Street, City, Zip): Phone:

Preferred Email: Ethnicity (Optional):

How did you hear about Momentum’s Upward Program?

Do you know anyone affiliated with Momentum? If yes, please list their name and relationship (friend, co-worker, etc):

Employment Current Employer:

Employer:

Supervisor name and email:

Title:

Length of time in this position:

Primary responsibilities:

Previous Employer:

Employer:

Supervisor name and email:

Title:

Length of time in this position:

Primary responsibilities:

Education Highest degree obtained:

High school diploma Bachelor’s MA/MS MBA JD EdD MD PhD

Field of Study:

Other

Professional Organizations

List any professional organizations you are a member of, length of affiliation, and any leadership positions:

1)

2)

3)

4)

Community Involvement

List any community service or civic involvement. Include length of affiliation, responsibilities, and leadership positions.

1)

2)

3)

4)

In an average month, how many hours do you spend on volunteer commitments in the community? _______

Short Answer Questions (limit to space provided)

1. What is your definition of leadership?

2. What leadership skills do you already possess? What skills do you need/want to develop?

3. Describe a situation in which you took a leadership role and helped to affect change.

4. What do you hope to gain from this program?

Additional Information

Please select 2 of the following topics and provide a written response (up to 300 words) on each: • Describe what career ownership means to you and how you exhibit it.• Explain examples of how you are motivated and how you motivate others.• What are your views on diversity and inclusion and why it is needed in organizations?• Describe how you have shown initiative on team projects.

Please include 2 letters of recommendation from references who can speak to your qualifications for Upward. These should include examples of your: demonstrating high degree of career ownership, self-motivation and capability of motivating others, appreciation for diversity, showing initiative in team projects and strong people skills.

Agreements & Signature

If selected for Upward, I agree that I will commit to attend all of the program dates and that only one absence is permitted in order to successfully complete the program. (Please initial.)

If selected for Upward, I understand the full tuition payment of $2,000.00 must be received by October 15, 2019 to secure my space. (Please initial.)

(Please check appropriate space)

My organization/sponsor will cover my tuition in full.

I will assume responsibility for my tuition in full.

I have financial needs which require me to seek scholarship assistance. (Please attach a brief written statement explaining why you seek assistance.)

I understand and acknowledge that once paid, my tuition for Upward is non-refundable and non-transferrable. (Please initial.)

I understand that throughout the program year, photographs or video may be taken to document the program. I agree that any photographs or video of me may be used by Momentum for marketing and public relations purposes. (Please initial.)

Signature: Date:

Employer Consent

Nominees for Momentum’s Upward Program must have the support of their employer.

This applicant has the approval and support of our organization, which includes the time necessary to fulfill the program requirements:

Employer:

Name of Manager or Sponsor:

Signature:

Manager/Sponsor Email:

Momentum Upward Program 2821 2nd Avenue South- Suite B1

Birmingham, AL 35233 205-321-6100

Email printed and signed document along with resume and two letters of recommendation by August 30, 2019 to application@momentumleaders.org.