1Personal Details2Program Requirements3References4Short Answer/Essay Your Name First Last Birth Date* MM slash DD slash YYYY Company/Organization* Job Role/Title* How many people do you influence at work?Direct Influence*I.e. direct reports, team members.Indirect Influence*I.e. coworkers that you regularly connect with, people who report to your direct reports, customers.Other*I.e. small group members, close friends, ministry team.Email* Phone*T-Shirt Size*SmallMediumLargeExtra LargeAddress* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Which class are you applying to?*2023Were you referred to the Workmatters Institute by an individual or organization? Yes No Name Email Program Requirements*Participation in the Workmatters Institute requires a significant amount of time and energy. (2 hours in class and 2-3 hours of preparation outside of class each week) Are you committed to being prepared each week? Yes No Financial Assistance*The standard tuition is $1,000, which covers all materials and expenses. Are you planning on applying for need-based financial assistance?*Please select an optionYesNoFinancial Assistance - More Detail*If yes, please explain. Workmatters will follow up with specific Financial Assistance materials. Character ReferenceYour character reference needs to be someone who can vouch for your character and spiritual maturity. Ideally this is someone who has insight into your spiritual leadership (pastor/elder, etc.)Character Reference First Name* Character Reference Last Name* Character Reference Email* Character Reference Phone* Work/Supervisor ReferenceYour work reference can be from a past (within last two years) or present employer and should be someone who can speak to your professional life and contributions.Work/Supervisor Reference First Name* Work/Supervisor Reference Last Name* Work/Supervisor Reference Email* Work/Supervisor Reference Phone* Please rate your following responses from "Strong Disagree" to "Strongly Agree."I believe God gave me certain gifts and talents to use for His glory.* Strongly Disagree Slightly Disagree Neutral Slightly Agree Strongly Agree I have a strong desire to grow and take ownership of my personal development.* Strongly Disagree Slightly Disagree Neutral Slightly Agree Strongly Agree I can clearly see how the work that I am doing is serving God or a higher purpose.* Strongly Disagree Slightly Disagree Neutral Slightly Agree Strongly Agree I am willing to take major risks to pursue God’s purposes for me.* Strongly Disagree Slightly Disagree Neutral Slightly Agree Strongly Agree I feel compelled to shape the culture at my workplace.* Strongly Disagree Slightly Disagree Neutral Slightly Agree Strongly Agree Why are you applying to the Workmatters Institute?*If selected, what do you hope to get out of the program?* Please discuss where you are in your faith journey.*What are some of the significant spiritual milestones in your life? Please provide an overview of your faith journey including where you are now. Please describe where you are in your career.*What is the biggest challenge you are facing right now that you hope WMI can assist you with? Where are you growing that you hope WMI will build on? What have you learned about yourself in your career so far? What would you like to say about yourself five years from today?NameThis field is for validation purposes and should be left unchanged.
