Leadership Development for Mid Career Women

(previously called Emerging Leaders)

* Required Fields

Contact Information

First Name: *
Preferred Name:
Last Name: *
Work Email: *
Personal Email: *

Employment Information

Employer: *
Industry: *
Address 1: *
Address 2:
City: * Province: *
Postal Code: * Country: *
Phone: *

Job Information

# years of work experience: *
Current Job Title: *
# years in current position: *
Main job responsibility #1: *
Main job responsibility #2: *
Main job responsibility #3:
Do you manage staff?: *
Do you have budgetary responsibility?: *
Are you a Rotman alumni? * If yes, which program:

How did you first hear about this program? *

- Which one?

- Which one?

- Please specify:

Tax Information

For tax purposes, an important step in the application process is to identify the source of payment for the program fees. Please choose one of the following: *

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