Apply

Thank you for your interest in The High-Impact Executive Program. Please complete the form below to submit your application for this program. Please allow two business days for our team to review your application and get back to you.

Before applying, please review our registration and refund policy .

Application Form

* = Required Field

Salutation * First Name * Last Name * Preferred Name * Email Secondary Email * Phone Number* Mobile Phone Number Other Phone

Mailing Address

Please provide an address where you can receive mail and packages related to your participation in this program. We recommend providing your home address.

* Street (list full street address, including apartment, floor, room, etc.) * City * State/Province * Zip Code * Country

Personal Information

* Birthdate (MM/DD/YYYY) * Gender * Country of Citizenship * Highest Level of Education * FIU Alumni Special Requirements Dietary Restrictions (On desktop, hold down the control/command key for multi-selections) LinkedIn Profile

Emergency Contact Information

Emergency Contact Name Emergency Contact Relationship Emergency Contact Email Emergency Contact Phone

Your Experience

* Your Current Job Title * What function best describes your current position? * Time in Current Role (in years) * Duration with Current Employer (in years) * Total Years of Work ExperienceTotal Years in a Supervisory/Leadership Role * How many people do you directly supervise?How many people do you indirectly supervise? * How many reporting levels are above you? * Job Title of Your Supervisor * Annual Compensation (in USD) * Annual Budget in Your Control (in USD) Areas of Expertise

Assistant Contact Information

Assistant Name Assistant Email Assistant Phone

Company Mailing Address

Please provide the mailing address for you to receive mail at your company.

* Street (list full street address, including apartment, floor, room, etc.)* City* State/Province * Zip Code * Country

Previous Leadership Program Attended

Program Attended Hosted By Year Completed

Additional Information

Additional Information regarding the Center for Leadership program for which you are currently applying.

* How did you hear about this program?Did your organization recommend you?Who is paying for your tuition? Why did you choose the Center for Leadership at FIU? Discount Code

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