Leaders Circles Program Application
Please select the type of Leaders Circles group you would like to join:
Leaders Circles Group for Executives
Leaders Circles Group for Managers, Emerging Leaders
Black, Indigenous, People of Color (BIPOC) Executives
Black, Indigenous, People of Color (BIPOC) Managers, Emerging Leaders
Leaders Circles Group for Executives in Greater Minnesota (virtual meetings only)
Contact Information
First Name
Last Name
Your Pronouns (they/them, she/her, he/him, etc.)
Organization
Title
Organization Street Address
Organization City
Organization State
Please select...
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Organization Zip Code
Direct Phone Number
Email
Organization Information
Years in Current Position
Organization Mission
Number of Paid Staff (FTE)
Please select...
0
1
2-5
6-10
11-20
21-50
51-100
100-500
501+
Annual Operating Budget
Please select...
Small ($0 - $100,000)
Small - Medium ($100,001 - $500,000)
Medium ($500,001 - $1,500,000)
Medium - Large ($1,500,001 - $3,000,000)
Large (Over $3,000,000)
Billing Information
When your Leaders Circle begins, you will be invoiced for the cost of participating, please indicate who should be invoiced:
Organization should be invoiced
I should be invoiced directly as an individual
Note billing address, if different from organization address above
How did you hear about Leaders Circles?
Please select...
Referred as a Target Grantee
Referred as a Pohlad Grantee
Other
Other Explanation
What do you hope to gain from your participation in a Leaders Circle?
How do you think participating in a Leaders Circle might benefit your organization?
What do you see as your greatest leadership challenge or potential for growth?
How do you think working with a group of your peers will strengthen your leadership?
I'm at point in my life where I'm ready to work on personal or leadership issues as they relate to my work.
Yes
No
I'm prepared to tackle the tough issues to close the gap between where I am now and where I want to be.
Yes
No
I'm open to new ideas and new ways of doing things to facilitate positive change and growth.
Yes
No
I'm prepared to devote the time needed to make my Leaders Circle a powerful experience for myself and my peers, including prioritizing time for meetings and homework.
Yes
No
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Contact Information