SQUAD Leadership Program Intake Form

Step 1 of 4

Company

This field is for validation purposes and should be left unchanged.

Name*

First Last

Current Company*

Current Job Title*

Email*

Please enter your preferred email address for all SQUAD Leadership Program communications

LinkedIn*

Location*

City State / Province / Region Country

What department or function best describes your role?*

Consulting

Data

Design

Engineering / Development

Finance / Accounting

HR (Talent Acquisition, DEI, Employer Brand)

Legal

Marketing

Operations

Product

R&D

Sales / Business Development

Systems Engineering / Applications

Other

Other*

Please describe your role or department here

Years of Experience*

5-9

10-15

15-20

20+

Other

Other*

Please enter your years of experience

Pronouns*

She/Her

He/Him

They/Them

She/They

He/They

Zee/Zir

Ey/Em

Other

I choose not to disclose

Other Pronouns*

Gender Identity*

Woman

Man

Transgender

Nonbinary

Gender Non-Conforming

Bigender

Cisgender

Gender Queer

Gender Fluid

Agender

Other

I choose not to disclose

Other Gender Identity*

Race/Ethnicity*

Asian

Black/African-American

Indigenous/Native American

Latinx

Native Hawaiian/Pacific Islander

Middle Eastern

White/Caucasian

Other

I choose not to disclose

Other Race/Ethnicity*

Sexual Orientation*

Lesbian

Gay

Ace/Asexual Spectrum

Bisexual

Pansexual

Queer

Straight

Ally

Other

I choose not to disclose

Other Sexual Orientation*

What skills or topics are you most interested in learning about / want to develop in order to achieve your career goals? (The more information you provide, including examples, the better. For example, do you want to hone your Decision-Making skills in specific situations, how to show up as an Authentic Leader, develop your Delegation skills, etc.)*

What do you feel you’re qualified to coach or teach others on? What are your top 3 areas of expertise?*

If we were to ask your teammates what your strengths are, what would they say?*

Tell us what you would like to be doing in 5 year? And what do you think is holding you back from getting there?*

What does success look like for you in this leadership program?*

What kind of support would be most helpful to you over the course of the program? Please provide specific examples.*

What are your current profession struggles?*

What are your habits or shortcomings that are currently preventing you from getting to the next level?*

What keeps you up at night about your job and/or career?*

Don’t Miss a Moment

Be the first to know about speakers, ticket drops, and surprise perks. Get SMS alerts — no spam, just the good stuff.