Consortium Application

Nominee's full name *

Nominee's title *

Organization name *

Does nominee meet the profile? *

	Meets	Partially meets	Does not meet
At least five years supervisory experience *	At least five years supervisory experience - Meets	At least five years supervisory experience - Partially meets	At least five years supervisory experience - Does not meet
Seen as a "high potential" *	Seen as a "high potential" - Meets	Seen as a "high potential" - Partially meets	Seen as a "high potential" - Does not meet
High performer preparing for "next level" *	High performer preparing for "next level" - Meets	High performer preparing for "next level" - Partially meets	High performer preparing for "next level" - Does not meet
Bears appropriate title *	Bears appropriate title - Meets	Bears appropriate title - Partially meets	Bears appropriate title - Does not meet
Can absorb complex information *	Can absorb complex information - Meets	Can absorb complex information - Partially meets	Can absorb complex information - Does not meet
Would be honored to be selected *	Would be honored to be selected - Meets	Would be honored to be selected - Partially meets	Would be honored to be selected - Does not meet
Will benefit from improving leadership and management skills *	Will benefit from improving leadership and management skills - Meets	Will benefit from improving leadership and management skills - Partially meets	Will benefit from improving leadership and management skills - Does not meet

Nominee is sponsored by *

Sponsor email *

Sponsor phone *

Nominee's email *

Nominee's phone *

Brief reason for nomination *

Brief note to nominating committee

Is Organization interested in full membership? *

Yes

In the future

No

Executive Education