Leadership Development Programs Form

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Leadership Development Programs Form

Personal Information

Full Name*

Phone*

Email*

Multi-line address

Country/Region*

Address*

City*

Zip / Postal code*

Birthday*

Month

Day

Year

Emergency Contact Information*

Educational and Professional Background

Current Education Level (if applicable) or highest level of education completed*

Employment Status

Student

Employed

Unemployed

Self-Employed

Current Job Title/Role (if applicable)*

revious Leadership Experience*

Leadership Development Goals

Specific leadership skills they wish to develop*

Short- and long-term goals for participating in the program*

Challenges they want to address*

Program Preferences

Preferred program type*

Group Coaching

One-On-One Mentoring

Project-Based Learning

Availability*

Preferred learning style*

Community Involvement and Interests

Current involvement in community activities*

Volunteering

Local Organizations

Civic Engagement

Other

Areas of interest

Youth Mentorship

Business Leadership

Community Service

Other

Interest in leading or participating in community projects during the program*

Mentorship Preferences

Mentor preferences (industry, gender, experience level, etc.)*

Previous mentoring experience (if any) and what they hope to gain from a mentor*

Areas where they need guidance (e.g., career advice, leadership challenges, personal development)*

Skill Assessment

Current strengths and skills they bring to the program*

Areas for improvement they wish to focus on*

Commitment and Participation

Willingness to participate in all scheduled program activities, including workshops, group projects, and mentoring sessions

Yes

No

Agreement to participate in follow-up assessments or feedback sessions to track progress

Yes

No

Consent and Agreement

Consent to share information with mentors and program coordinators for personalized guidance

Consent

No Consent

Commitment to program guidelines and respectful participation in all activities

Consent

No Consent

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