APPLICATION - Spring 2014
Designed for mid to upper-level women, WE Succeed is an intensive,
three month professional development program facilitated by an
executive coach in a small group format.
Instructions: Click on the shaded areas to input information. Save this document
to your own computer using your last name as part of the file name. Contents of
this confidential application will only be shared with the selection committee and
program staff.
DATE:
SESSION PREFERENCE (Please click on the box for each timeframe and select the
appropriate choices.) Actual session days/times will be set to accommodate group
members.
Tuesday:
8:30 to 10:30 am ----------
Wednesday:
8:30 to 10:30 am ----------
Other (fill in day(s) time(s) only if not available for any of the above):
CONTACT INFORMATION
NAME
HOME ADDRESS
CITY
PRIMARY PHONE #
STATE
ZIP
Business
SECONDARY PHONE #
Business
E-MAIL
COMPANY/ORGANIZATION NAME
POSITION
BUSINESS ADDRESS
CITY
STATE
ZIP
What is the nature of the business/organization?
Years lived/worked in region?
OPTIONAL: To help us achieve a diverse program, please provide the following
information:
Birth date
Race/Ethnicity
LEADERSHIP PROGRAM HISTORY
Which leadership program(s) have you completed?
WE Lead
Class # or Year
C-Change
Class # or Year
Leadership Cincinnati Class # or Year
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Other programs - please supply the program’s name, provider and brief
description (including length and focus) either below or in an attachment.
EMPLOYMENT
(Beginning with your present employer, please list your last three positions.)
From – To
Name & Location of Employer
Position
ORGANIZATIONS AND ACTIVITIES
Please list current membership in community, civic, business, professional,
religious and social organizations.
Organization
Role or Position Held
Because WE Succeed is designed as an intensive, short-term program it’s important
for you to begin with some goals in mind and to have an awareness of how to create
a strategic plan for achieving those goals.
1. Please answer the questions below in responses of not more than 75 words each.
a. What one or two goals would you like to concentrate on during WE Succeed?
b. What do you hope to gain from your WE Succeed experience?
2. If you are a WE Lead alumna, did you complete a personal strategic plan (PSP)?
yes
3. If not a WE Lead alumna, have you ever created your own personal strategic plan
or participated in a strategic planning process for an organization?
yes - personal
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ATTENDANCE REQUIREMENTS
Participants are expected to attend all sessions and phone calls. Session times
will be set to best accommodate the needs of each group. The initial session will
be 4.5 hours and subsequent sessions will be 2 hours.
 Group A Sessions on Tuesdays - Apr. 15, Apr. 29, May 13, May 27, June 10 and
June 24
 Group B Sessions on Wednesdays - Apr. 16, April 30, May 14, May 28, June 11
and June 25
 Bi-weekly phone conversations with accountability partner during non-session
weeks
 Monthly individual phone coaching sessions up to ½ hour each
Will you be able to fulfill this commitment?
Yes
No
Do you have full support of your employer for the required time off from your
position?
Yes
No
NA
TUITION
Tuition for each participant is $1,800 and is due in full by April 11, 2014 unless
arrangements have been made to pay in installments. Tuition is non refundable.
Tuition will be paid as follows: (If combination, indicate amounts)
Personally
Sponsoring organization/company
REFERENCES
Please list two references who are knowledgeable about your leadership performance
and potential.
Primary Reference – must be your supervisor or other employer representative
NAME
PHONE
COMPANY/ORGANIZATION
ADDRESS
E-MAIL
NAME
PHONE
COMPANY/ORGANIZATION
ADDRESS
E-MAIL
I understand the purpose of WE Succeed and will devote the time and energy
necessary to make it a successful experience if I am selected to be a participant.
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Candidate’s Signature
Date
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APPLICATION PROCESS CHECKLIST
PLEASE RETURN:
1) Completed Application
2) $25 application fee (nonrefundable)
 Enclose a check payable to Cincinnati USA Regional Chamber
or
 Call 579-3111 to pay by credit card
SUBMIT VIA EMAIL, MAIL OR DELIVER TO:
Diana Long - WE Succeed
dlong@cincinnatichamber.com
Cincinnati USA Regional Chamber
300 Carew Tower, 441 Vine Street
Cincinnati, OH 45202-2812
APPLICATION DEADLINE: March 21, 2014. (Must be postmarked by this date to be considered.)
WE Succeed is presented by:
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