HELC Application

HELC Application
Contact Information
Name

First NameLast Name
Company Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Personal Email
example@example.com
Employment Information
Name of Current Employer:
Website
Industry (Energy, Professional Services, Manufacturing, Logistics, etc.)
Job Title/Position:
Years of Experience
Interest In The Program
Why are you interested in participating in the Houston Energy Leadership Cohort?
Why do you believe a program like Houston Energy Leadership Cohort is important?
What specific knowledge or skills do you hope to gain from this program?
How do you envision applying what you learn to your professional environment?
Additional Information
When would you like to participate In:
How did you learn about the Houston Energy Leadership Cohort?
Did a company or person refer you? If so, who?
Please share any accommodations needed for your successful participation in and completion of this program. (e.g. dietary restrictions or allergies, accessibility requirements)
If selected for the cohort, do you or your company have the financial resources to cover the cost of tuition? If yes, please provide a point of contact and their contact information.
Please provide two professional references.
Reference 1

First NameLast Name
Reference 1 Employer:
Reference 1 Title
Reference 1 Email
example@example.com
Reference 1 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Reference 2

First NameLast Name
Reference 2 Employer:
Reference 2 Title
Reference 2 Email
example@example.com
Reference 2 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Please upload your resume.

Cancelof
If accepted:
- I understand that a one-time non-refundable program tuition payment of $7,000 is due upon acceptance to the Houston Energy Leadership Cohort.
- I understand that through my participation of this program, pictures, video or other media may be collected chronicling the cohort’s experience.
- I understand that my name, title, company and likeness could be used in future Partnership and cohort materials for the purpose of documenting, marketing, or otherwise communicating about this program.
- I commit to attending and completing coursework for a minimum of 7 sessions for successful completion of this program.
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearPlease enter today's date.
Please verify that you are human
By submitting this application, you acknowledge and agree to fully participate in the Houston Energy Leadership Cohort. Participants are expected to attend at least 7 sessions, site visits, and cohort activities as part of the program commitment.
Lead Source
Suspect Source Detail
Source Program
Source Year
Source Period
Submission Filename
Today's Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Application Summary Long
Should be Empty:

HELC Application

Contact Information

Employment Information

Interest In The Program

Additional Information