1Personal Details2Program Requirements3Short Answers Your Name First Last Company/Organization* Job Role/Title* How many people do you influence at work?Direct Influence*I.e. direct reports, team membersIndirect 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* Please enter the email that is associated with your Zoom account.Phone*Date of Birth*MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Shirt Size*SMLXLXXLAddress* 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?*Fall 2023 Young Professionals (Little Rock)Fall 2023 Senior Leaders (Online)Were you referred to the Workmatters Institute by an individual or organization? Yes No Did you attend the 2022 Workmatters Conference either in-person or via livestream? 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*Class tuition is $299, due before start of class. Please indicate your specific needs regarding tuition.Please select an optionI plan to pay in full before class begins on March 20.I would like to pay in installments.My company has already paid for my spot.I’m not sure.Financial Assistance - More Detail*If yes, please explain. Workmatters will follow up with specific Financial Assistance materials. Please rate your following responses from "Strongly 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.*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? PhoneThis field is for validation purposes and should be left unchanged.
