Elevate Program Application

Elevate Program Application

This application can be saved and continued later via the button at the bottom of the application. Drafts not submitted within 2 months are automatically deleted. The application is broken into several sections for ease of navigation; be sure to complete all required questions in each section. The final step in the application process is the submission of an application fee of $125 ($75 for repeat applicants).
Applications can be submitted at any time. Applications submitted between May 1 and August 31 may be placed on a waiting list to be considered for the next cohort beginning in September and/or consideration for the following cohort. Please check the option below to indicate if you would like to be considered for the cohort beginning in September.

Please consider my application for the cohort beginning in September

Personal & Contact Information
Salutation*
First Name*
Middle Initial
Last Name*
Suffix
Nickname/Preferred Name
Please indicate how you would prefer to be addressed (i.e., what name you prefer to have on a nametag).
Preferred Pronouns
Please indicate if/how you would like your pronouns to appear on a nametag.
What other LM programs (if any) have you participated in?

Business Leaders Impact CouncilCOREEmerging LeadersEncoreREAL InclusionSenior Leadership MontgomeryOther
Mobile Phone*

Area CodePhone Number
Secondary Phone

Area CodePhone Number
What type of number is your secondary phone?
Which is your preferred phone?*
Primary Email*
List the primary email you would like to use for Leadership Montgomery communications.
Additional Email*
Please list a secondary email should we be unable to reach you via your primary email.
Administrative Assistant Email
If you would like an administrative assistant to be copied on all Leadership Montgomery communications, please input that email address here.
What is your primary/preferred address?*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please indicate your primary/preferred address type.*
Secondary Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please indicate your secondary address type.
How many years have you lived in Montgomery County?*
How did you hear about Leadership Montgomery?*
Please specify
If a person, please list a name - we'd love to thank them!

Professional Affiliation & Employment History
For most applicants, this is an employer. If you are retired, please indicate your last employer, position, or field with a "retired" as your job title.
Organization/Employer*
Job Title*
Organization Category*
Please select the category that best describes your organization
Organization Industry*
Please choose the category that best describes what your organization does.
How many direct reports do you have in your current position?
How many total employees do you oversee, inclusive of direct and indirect reports?
How will you share your Employment History, Education, & Awards/Recognition*

Upload a PDF resumeEnter manually below
Upload a resume in lieu of answering following questions regarding employment and education

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Employment History, Education, & Awards/Recognition
Employment History

List previous positions, beginning with the most recent first. Include active military duty, if applicable:
Employer 1
Title/Responsibility 1
Employer 2
Title/Responsibility 2
Employer 3
Title/Responsibility 3
Describe your current company/organization:
Describe your responsibilities at work:
If you upload your resume, please insert N/A to continue with application.
Education

Begin with the most recent, and include high school or equivalent, college(s), and any postgraduate studies.
School Name, City & State 1
Degree Awarded 1
School Name, City & State 2
Degree Awarded 2
School Name, City & State 3
Degree Awarded 3
Special Awards/ Honors
Presented By 1
Award/Honor 1
Year 1
Presented By 2
Award/Honor 2
Year 2

Open Ended Questions
How have you navigated the transition into a senior leadership position? What have you learned about yourself as a leader during this process?
How would you describe your current leadership style, and what areas would you like to develop further?*
What is one long-term goal you have for your leadership role, and how are you preparing yourself and your organization to achieve it?
Is there any additional information that you believe would assist the Selection Committee in assessing your qualifications?*

Upload Letters of Recommendation
TWO letters of recommendation must be submitted via PDF upload below. Letters of recommendation are an important part of the selection process and must cite specific attributes of the candidate. Letters of recommendation should include the nature and duration of the relationship between the writer and the candidate. If you are applying with a sponsoring organization, and you are NOT the CEO/President, at least one letter should be from your CEO or a senior manager in the organization stating their full support of the candidate, including recognition of the time commitment and the financial obligation of tuition.
Reference Letter 1*

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Reference Letter 2*

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Tuition and Funding
Tuition for participants accepted to Leadership Montgomery's Elevate program is $4,000, billable upon acceptance into the program. Participants whose participation is sponsored by an employer or other organization are required to contribute 10% of the tuition ($400) as a demonstration of personal commitment. Payment plans and tuition assistance are available upon request.
Tuition Options (check all that apply)

Bill 90% of tuition to sponsoring organization (specify below) and 10% to applicantBill 100% of tuition to applicantPayment plan requested (LM will follow up with payment plan options)Tuition assistance requested (application below)
Sponsoring Organization

Tuition Assistance
Tuition Assistance Form

Tuition assistance is considered separately from your application and has no influence or effect on the Selection Committee's evaluation of your application. Tuition assistance requests must be submitted at the time of application. All information will remain confidential. **PLEASE NOTE** You must download or print the form, then upload the completed form and supporting documents in PDF format using the upload functions below.
Completed Tuition Assistance Form

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**REMINDER** You will need to download or print the form above, then upload the completed form here. Cancelof
Supporting Document 1 (i.e 1040/990)

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Supporting Document 2 (i.e 1040/990/other)

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Statement of Commitment & Application Fee
If selected to participate in the next Elevate Class, I agree to secure payment or payment plan contract for the entire nonrefundable tuition of $4,000 by July 15th prior to the program start date. I understand that I am required to attend each session and meet the attendance requirements as outlined in the program description, and that missing more than 13 hours could result in dismissal from the program.
Applicant's Signature

Clear
Leadership Montgomery requires certification by submitting an electronic signature.*

Confirm Signature

To finalize your application, please pay the Elevate application fee: *

Elevate application fee$125.00

$125 for first-time applicants.

Total $0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Please verify that you are human*

Save or Submit
You may save and continue your application via the save button below.

NOTE: JotForm deletes unsubmitted applications after 60 days. All required fields (marked with a red asterisk*) must be completed before the application can be submitted. This includes the two required letters of recommendation.
If you have any trouble submitting, try saving your documents to your desktop and reupload them to the form – we’ve been hearing about challenges with the uploaded documents when uploaded from cloud-based servers.
Should be Empty:

Employment History

Education

Special Awards/ Honors

Tuition Assistance Form

You may save and continue your application via the save button below.