PIE&G Leadership University Application Form

PIE&G Leadership University Application Form

Apply to participate in PIE&G Leadership University's two-session, half-day immersive program.
Applicant Name

First NameLast Name
Primary Email Address
example@example.com
Primary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Preferred Contact Method
Employer / Organization
Job Title / Role
Are you a current PIE&G member?
Why are you interested in PIE&G University?
What do you hope to do with what you learn in this program?
Please describe any scheduling conflicts you have during November and December (include specific dates/times if known).
Which session times are you generally available?
Do you require any accommodations to participate (accessibility, dietary needs, etc.)?
Have you previously served on a board or community committee?
If yes, please briefly describe your past or current board/community service experience.
Consent to be contacted about future PIE&G leadership or engagement opportunities.
Consent for photography/video use for PIE&G communications related to this program.
Should be Empty: