MMI Participant Application Form
How long have you been in your current position?
Office Telephone (with area code)
Mobile (with area code)
Preferred Mailing address
Street Address Line 2
State / Province
Postal / Zip Code
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.
Number of years you have worked (full time)
How many years have you worked (full time) in the following settings?
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?
Should be Empty: