DEI Professional Leadership Program Application

DEI Professional Leadership Program Application
Hello! Thank you for your interest in applying for the DEI Professional Leadership Program. Please know that the information you provide will be held as confidential, and used to determine the best fit for the current cohort of the DEI-PLP. If you have any problems with this form, please contact Susana Rinderle directly at susana@wordswisdomwellness.com.

We look forward to reviewing your application!
Name *

First Name Last Name
Email *
example@example.com
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Best Phone Number *
Please enter a valid phone number.
Website URL (if applicable)
URL to your LinkedIn Profile

BASIC QUESTIONS to get to know you better
What inspired you to apply to the DEI-PLP? *
What is your current work situation (job, organization, role) and your professional goals? *
What do you hope to gain from participating in the DEI-PLP? *
What will you contribute to the DEI-PLP learning community (your cohort)? *
What will you be better able to contribute to the world after completing the DEI-PLP? *
What is your current awareness, knowledge and skill level around DEI? *
What attitude and actions -- from us and from yourself -- will best support your learning? *

BASIC AGREEMENTS to check our alignment
The DEI-PLP lasts up to six months and requires an average of 8 hours per week. Are you ready, willing and able to make that commitment? *

Yes No I'm not sure It depends
The DEI-PLP requires an investment of $3995 per person. How will you make that investment? (Ex: your organization's budget, your personal funds, preferred payment plan) *

DEMOGRAPHIC QUESTIONS to better understand your context
How do you identify in terms of race, ethnicity and nationality? *
How do you identify in terms of gender, gender identity and sexual orientation? *
What are your pronouns? *
How do you identify in terms of disability, age/generation and veteran status? *
What other languages do you speak and/or write besides English, and how fluently? *
What else is important for us to know about you or your identity?

WRAPPING UP!
What concerns or doubts do you have about your participation in the DEI-PLP? *
What questions do you have?
(Optional) Please upload your résumé:

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Thank you for completing your application! Please be sure to click on "Submit" so we receive it right away. You will hear back from us within a week.
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BASIC QUESTIONS to get to know you better