EXCEL Application
Name
*
First Name
Last Name
Organization Name
*
Email
*
example@example.com
Gmail Address
(The EXCEL program uses Google Classroom to share materials and exchange messages with the class. In order to access Classroom, you will need a Gmail account. If you have a Gmail address, please enter it above. If you currently don't have a Gmail account, please sign up for one and provide the address as soon as possible.)
Work Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Work Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Cell Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
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Current Job Title
*
Description of Role and Responsibilities
*
In addition to regular responsibilities, include information about your position in the organizational structure, whether you are part of the agency senior leadership team, and your understanding of and involvement with the entire organization, rather than just a specific program.
Number of Years in Present Position
*
Number of People You Directly Supervise
*
0
1-10
11-25
26-50
51-99
100 or more
Number of Years with Current Employer
*
Your Supervisor
*
Supervisor's Name
Supervisor's Title
*
Supervisor's Email Address
Supervisor's Phone Number
How many levels of management are there between you (the applicant) and the ED/CEO?
*
I am the ED/CEO
1 - I report directly to the ED/CEO
2 - I report to one of the ED/CEO's direct reports
3 levels
4 or more levels
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Desired Session
*
2024-25
2025-26
2026-27
Why Are You Interested in EXCEL?
*
What Are Your Expectations of the EXCEL Program?
*
What Topics Would You Like To See Included in this Leadership Program?
*
How Did You Hear About EXCEL?
*
LinkedIn
Email Campaign
Another Participant
Recruiter for NLIGC
Your Supervisor
Other
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Age
*
18-24
25-39
40-55
over 55
Prefer not to answer
Gender
*
Female
Male
Transgender
Non-binary
Prefer not to answer
Race
*
American Indian or Alaska Native
Asian
Black/African American
Native Hawaiian or Other Pacific Islander
White
Multi-Racial
Prefer Not to Answer
Other
Ethnicity
*
Hispanic or Latino
Not Hispanic or Latino
Prefer not to answer
Approximate number of people your agency serves
*
100 or less
101-500
501-1000
1000-5000
More than 5000
Prefer not to answer or Unknown
Please confirm that you are familiar with all of the requirements of the program listed below: (check all)
*
Payment of Tuition is required prior to the start of the first class.
Attendance is mandatory for all sessions (except where excused in advance or in case of an emergency).
You have the full support of your employer for the required time away from office
There are some limited scholarship funds available to assist agencies with the cost. Please indicate if there is a need for financial assistance. (We cannot guarantee that all requests for financial assistance will be filled.)
*
I may need financial assistance in order to participate in EXCEL.
No financial aid is needed
Thank you for your interest in the EXCEL program. Someone will follow-up with you soon.
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