Intake Form | C Factor

C Factor Intake Form

Registration

To register, please take the time to fill out the information below.

Name

Organization

Job Title

Personal Address

State/Province

ZIP/Postal Code

Phone

Preferred Pronouns

Organization Address

State/Province

ZIP/Postal Code

Did someone encourage you to apply to the C Factor Program? If so, please provide their name.

Please list any earned post-secondary diplomas/degrees you have received.

Have you taken any formal leadership training or coaching in the past?

Yes

If yes, please let us know what training or coaching you have completed.

What are your biggest management/leadership challenges?

What are your leadership goals and aspirations?

What do you hope to achieve by joining the C Factor Leadership Program and Community?

I agree to the time commitment of the 7-week C Factor Leadership Program, which may include up to 15 hours of synchronous face-to-face training (virtual) and 15 hours of asynchronous learning (e.g., watching videos, taking assessments, doing self-reflection exercises, and reading articles).

Does your employer understand and support the time requirement for the 7-week C Factor Leadership Program?

Yes

Your Signature