Personal Information

Salutation

First Full Name

Middle Name or Initial(s)

Last Name

Nickname

Job Title

Occupation

Are you a:

Federal Government EmployeeState or Local Government Employee

Are you a:

Federal Government EmployeeState or Local Government Employee

Department or Agency

If your agency is not listed, type and select "Other".

Other Department or Agency

Please avoid acronyms

Subcomponent (please avoid acronyms)

State

City, County, or Municipality

Agency Name

What level of government do you primarily work for?

Other level of government:

Office or Work Unit

Please avoid acronyms

Full Agency Name Preview

Above is how your agency name will appear in our records. If this naming convention is incorrect, please check the box below.

Override agency naming convention

Full Agency Name- Manual Input

Contact Information

Work Email

Personal Email

Preferred Email Address

Preferred Phone Number

Work Phone

Mobile Phone

Home Phone

Street

City

State

Zip Code

Emergency Contact Name

Emergency Contact Phone

Supervisor Information

Salutation

Supervisor First Name

Supervisor Last Name

Supervisor Job Title

Supervisor Phone

Supervisor Email

City

State

Zip Code

Professional Experience and Objectives

Total years with current agency

Numerals only

Total years of government service

Numerals only

GS Level or Equivalent

Specify GS Level or Equivalent

Are you a leader of:

Emerging Leader (Team or work group member/ aspiring supervisor/ developing technical expert)Leader of Teams or Projects (Team or work group leader/ project leader/ new supervisor/ technical expert)Leader of Organizations (Executive and enterprise leader/ cross-sector, interagency and intra-agency convener/ organizational driver of change)Leader of Leaders (Office, division or large-team leader/ program portfolio leader/ mid-level supervisor/ technical leader in the field)None of the above

Number of employees you supervise

Why have you chosen to apply for this program? Describe one thing you hope to take away from it. Limit 250 words.

How knowledgeable are you about AI and its applications? Note: This does not impact your ability to participate in the program. We welcome people with varying skills and experience.

No knowledge (I know that there is something called AI but I don’t know what it is.)Basic knowledge (I am familiar with some basics such as voice recognition or cognitive services, but have never been involved in a project that involved AI.) Working knowledge (I have been involved in some projects where AI was used.) Deep knowledge (I have been heavily involved with AI technologies and their applications in my work.)

What business challenge(s) are you experiencing where you hope to apply AI? Please provide one example.

Supplemental Information

How did you hear about this program?

Other

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