MMI Participant Application Form
Full Name
First Name
Last Name
Title
How long have you been in your current position?
Institutional Affiliation
Office Telephone (with area code)
Mobile (with area code)
Preferred Mailing address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Country
Preferred email address
Please indicate any special services, accommodations, or needs which may be necessary during the program (i.e. Sign Language interpreting, accessible materials, dietary restrictions). If more space is needed than provided, indicate below and continue on a separate sheet.
Upload Special Services Document
8. I am interested in being considered for one of the $240 merit-based scholarship. Please attach a letter of recommendation from your supervisor.
Yes
No
Number of years you have worked (full time)
How many years have you worked (full time) in the following settings?
Public Institution
Private Institution
Community College
For-Profit Institution
Corporate/Association Setting
Please provide responses to the following questions:
What do you hope to gain from MMI 2015?
What are the biggest challenges you face as a mid-level manager?
What are the job titles and general responsibilities of the staff members you directly supervise?
What is the job title of your direct supervisor and their general responsibilities?
Do you oversee a budget? How much?
How many other mid-level managers do you work with directly?
Upload Resume
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