Advanced Tech Leaders Registration Contact Information * Required *First Name Middle Initial *Last Name *Title *Company *Company Address Line 1 Company Address Line 2 *City *State ---ALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY *Zip-Code *Phone *Your Email (required) Questions *What are the major challenges you face as an IT leader today? *List three characteristics that are essential for an IT manager to posses in order to be successful? *How would participating in the IT Leadership Academy help you do your job better? Leadership Experience Please list any organizations in which you have held volunteer, elected or appointed positions. Criteria for selection includes leadership potential as communicated by sponsoring organization, motivation, ability to identify and meet IT challenges and how knowledge from IT Leadership Academy will be used to positively affect the larger IT community. Organization - No. 1 Position Held Duration Responsibilities Organization - No. 2 Position Held Duration Responsibilities Accountability Partner Please select your manager or a direct report from your organization to serve as your Accountability Partner (AP) during the program. Your AP will spend time with you each month discussing the session and finding ways to implement the session concepts within your work environment. *Name *Email Address (required) *Title Participant Conditions By checking this box, I hereby state that the above information is correct to the best of my knowledge. I have obtained approval from my employer/manager (if applicable) to participate in the IT Leadership Academy. * Employer/Manager Name * Employer/Manager Title All parties involved understand the time and financial commitment required for completion of the program.