Own Your Influence Application
Please answer all questions below to help us improve your experience.
CONTACT INFORMATION
Name
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First Name
Last Name
Email
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example@example.com
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
BACKGROUND INFORMATION
Current Role/ Title
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Company/Organization
Industry/Sector
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Years Of Experience in STEM Fields
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0-5 years
6-10 years
11-15 years
More than 15 years
Tell Us More
There are no right answers. We're looking for honest reflection — not a polished response. Take your time.
Briefly describe your current role and the types of high-stakes conversations or decisions you're responsible for.
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This helps us understand the rooms you're already in — and whether the program is built for your level.
Describe a recent moment when you held something back in an important conversation — even though you saw the opportunity or the risk clearly. What stopped you?
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This is the heart of the work. Your answer helps us understand exactly where the gap lives for you — and how to address it.
What would it mean for your career — and for you personally — if your presence in the room consistently matched the level of expertise you've already earned?
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Your answer to this is the reason you're here. Take a moment with it.
Where do you see yourself in 12 months?
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What's the greatest challenge you are encountering in your life in this moment?
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Please provide any additional information you believe is relevant to your application
I understand this is an application, not a purchase. Submitting this form does not guarantee enrollment. I'll receive a follow-up within 48 hours to discuss fit and next steps. I agree to be contacted by Noteworthy Consulting at the email and phone number provided above.
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Yes
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