Boulder-CU Leadership Program Application

Name *

Professional/Academic Suffix

Job Title & Company (Retired if applicable) *

Email *

Phone *

What is your LinkedIn public profile address, professional website, or business link ? (If not applicable, put N/A)

Tell us a little about your professional background and some interesting facts that you think prospective mentees may want to know about you. (please limit your response to 150 words as it will be used for your bio) *

Please offer a few words of advice to students based on your leadership experiences. (please limit your response to 150 words) *

Please select areas of interest or expertise: *

Are you willing and able to commit to a 14-hour requirement for this program? *

Yes

No

Have you ever been convicted of a felony? *

Yes

No

Please explain *

Referred by:

Reference Email Address

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Boulder-CU Leadership Program Application