Executive Education Programs Application Form | The Center for Excellence in Public Leadership (CEPL)

Applicant's Contact Information

First Name *

Last Name *

Title *

Grade *

Please enter NA if not applicable

Organization *

Street Address *

Suite

City *

State *

Zip *

Country

Work Phone *

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Cell Phone *

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Work Email *

Personal Email *

Name for Graduation Certificate *

Please write your name, as you would like to have it spelled on the graduation certificate from The George Washington University.

Program for Which You Are Applying

Room and board are not included into the cost of the programs.

Are you an alum of The George Washington University or GW Center of Excellence in Public Leadership?

Yes

No

Is your organization sending five or more individuals to the program? *

If yes, your organization would be eligible for a group discount

Yes

No

I don't know

Are you a member of: *

AFERM

FEW

None of the Above

Program Interest Questions

Please respond to the following questions:

What do you hope to get from the program? Are there any specific topics you would be particularly excited to explore?

Describe 1-2 leadership challenges that you are currently facing and hope to address in the program?.

Other things we should know?

This is a good place to mention if you require special assistance, or would need to miss a portion of the training for any reason.

Referral Contact Information

How did you hear about the program? If you have a referral’s contact information, please provide it below, so that we can thank them.

First Name

Last Name

Title

Organization

Work Phone

Please enter phone as (XXX) XXX-XXXX

Work Email

Training Representative Contact Information

Please enter NA if not applicable

First Name *

Last Name *

Title

Organization

Work Phone *

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Work Email *

Point of Contact for Payment

Please enter NA if not applicable

First Name *

Last Name *

Title

Organization

Work Phone *

Please enter phone as (XXX) XXX-XXXX

Work Email *

Purchase Order: *

Please review our payment policies. You will be contacted by the GW-CEPL Financial Administrator for payment.