ADVANCE Application
Name
*
First Name
Last Name
Organization Name
*
Email
*
example@example.com
Gmail Address
(The ADVANCE 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 Responsibilities
*
Number of Years in Present Position
*
Number of Employees You Directly Supervise
*
0
1-2
3-9
10-49
50-99
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
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Desired Session
*
Spring 2026 (March - May)
I would like to be on the list for 2026 Fall ADVANCE training (dates TBD)
Why Are You Interested in ADVANCE?
*
What Are Your Expectations of the ADVANCE Program?
*
What Topics Would You Like To See Included in this Leadership Program?
*
How Did You Hear About ADVANCE?
*
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
Thank you for your interest in the ADVANCE program. Someone will follow-up with you soon.
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