Susan L. Henricks Defining Leadership Scholarship Application Form

Important Information

Please note:

The Defining Leadership for Men and Women programs are 8-day programs (4 sessions that meet 2 days back-to-back over 4 months) and all sessions are mandatory. Applicants must have endorsement and permission to attend all sessions, if applicable, from their company and/or leader to apply for the scholarship.

Dates for Defining Leadership for Women Spring 2025: February 6-7, March 6-7, March 27-28, May 1-2 with an orientation on February 5 & a celebration on May 1.

Date for Defining Leadership for Men Spring 2025: February 20-21, March 20-21, April 10-11, May 8-9 with an orientation on Feb. 19 & a celebration on May 8.

Please confirm your availability to participate in the above program dates before submitting an application.

First Name

Preferred Name:

Last Name:

Title (i.e. Director of Marketing):

Company Name:

Business Address:

Business Address 2:

Business City:

Business State

Business ZIP/Postal Code

Business Phone:

Business Email:

Personal Email:

Business Fax:

Home Address:

Home City

Home State

Home ZIP/Postal Code:

Phone:

Cell Phone:

What size is your organization?

How did you hear about the Susan L. Henricks Defining Leadership Scholarship?

Why are you applying for this scholarship?

What makes you deserving of the Susan L. Henricks Defining Leadership Scholarship?

What would this scholarship mean to you? How would it impact your career?

Is there additional information you would like to share about yourself that would allow the selection committee to get to know you better (i.e. Please consider adding letters of endorsement and/or your job description here).

Have you ever attended an ICAN program?:

Please list ICAN programs you've attended:

I UNDERSTAND THAT ALL INFORMATION SUBMITTED WILL BE USED BY THE ICAN, INC. OFFICE AND THE SELECTION COMMITTEE ONLY. FACILITATORS PLEDGE ABSOLUTE CONFIDENTIALITY REGARDING INFORMATION CONTAINED IN ALL ASSESSMENTS.

I Accept These Terms

I UNDERSTAND THAT SUBMISSION OF THIS COMPLETED APPLICATION INDICATES THAT BOTH MY EMPLOYER AND I HAVE REVIEWED AND ACCEPT THE PROGRAM'S REQUIRED COMMITMENT OF TIME. ALL SESSIONS ARE REQUIRED. SUBMISSION OF A COMPLETED APPLICATION INDICATES YOU ACCEPT THESE TERMS.

I Accept These Terms

Contact Information