Training Application

Training Application

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Resume Later

In order to be able to resume this form later, please enter your email and choose a password.

Your Email:

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Instructions

Please complete the following form. The process typically takes 15-20 minutes.

If you need to stop and resume at a later time, there is a checkbox (above) that enables you to save your progress. Required fields are marked with an asterisk (*). You will need to provide your email address and password each time you save your application. An email with a link to resume your application will be sent to the email you provide.

Once you complete the form, click "Next" to review your application. Afterwards, click "Confirm" to send us your application. You will receive an update on the status of your application in 10-12 business days.

Seminar Choice

What program are you interested in?

Please select your first choice of training dates/site

Please select your second choice of training dates/site

How did you hear about Rockwood?

Colleague/Supervisor/Employee	Friend	Funder/Grantee
Postcard/Brochure	Advertisement	Conference
Rockwood newsletter	Internet Search	Blog
Twitter	Facebook	LinkedIn
Not mentioned above

Please select all that apply.

Please specify how you heard about Rockwood

Affiliation/Fees

The training fee for Rockwood trainings is based on a sliding scale, weighted against your organization's budget or assets in the current year. Participants are expected to cover their travel costs.

To determine your training fee, please indicate the type of organization you work for and its budget or asset range. The fee that displays is an estimate for the program you are applying for; the actual fee will be listed in the invoice you receive upon acceptance.

What is your current affiliation?

Nonprofit Organizations: Please provide your total organizational expenses from the most recent fiscal year

Nonprofit Organizations: Please provide your total organizational expenses from the most recent fiscal year

Nonprofit Organizations: Please provide your total organizational expenses from the most recent fiscal year

Foundations: Please provide the current level of your endowment or your total foundation assets from the most recent fiscal year

Foundations: Please provide the current level of your endowment or your total foundation assets from the most recent fiscal year

Foundations: Please provide the current level of your endowment or your total foundation assets from the most recent fiscal year

For Profits: Please provide your total company expenses from the most recent fiscal year

For Profits: Please provide your total company expenses from the most recent fiscal year

For Profits: Please provide your total company expenses from the most recent fiscal year

Tuition Calculated

$

If you have a coupon code from us, please enter it here

Organization Contact Info

Organization Name

If you're not affiliated with an organization, please enter "Unaffiliated" above

Acronym

Organization Website

If you do not have a website, please enter "N/A" above

Organization Twitter Handle

Work Mailing Country

Work Mailing Street Address

Work Mailing City

Work Mailing State/Province

Work Mailing Zip/Postal Code

Individual Contact Info

First Name

Middle Initial

Last Name

Preferred Name

If you prefer to go by something other than your Full First Name, please let us know.

Certificate Name

Please provide your name as you would like it to appear on your certificate of completion.

Work Email

Personal Email

Preferred Email

Personal Twitter Handle

Work Phone

Mobile Phone

Preferred Phone

Home Country

Home Street Address

Home City

Home State/Province

Home Zip/Postal Code

Position/Title

Years working in the social change sector

Please supply a brief description of the work your organization does and your role there

Please supply a brief summary of what you hope to learn in this training

Please comment on your ability to learn in a cohort of leaders from diverse demographic backgrounds, especially diverse experiences of race, power, and privilege.

Have you had previous leadership training? If so, please list

Personal Email

Work Email

Preferred Email

Personal Twitter Handle

Mobile Phone

Work Phone

Preferred Phone

Home Country

Home Mailing Street Address

Home City

Home State/Province

Home Zip/Postal Code

Position/Title

Years working in the social change sector

Please supply a brief description of the work you do

Please supply a brief summary of what you hope to learn in this training

Please comment on your ability to learn in a cohort of leaders from diverse demographic backgrounds, especially diverse experiences of race, power, and privilege.

Have you had previous leadership training? If so, please list

Organizational Information

What best describes the geographic scope of the work you currently do?

Local	Regional: Multi-county
State	Regional: Multi-state
National	International
Not mentioned above

Please select all that apply.

Please specify

On what issues does your organization focus?

Arts/Culture	Environment/Sustainability	Spirituality/Faith
Civil/Human Rights	Immigration	Technology
Economic Issues	Media	Violence Prevention
Education/Youth	Reproductive Health, Rights, and Justice	Workers' Rights
Electoral Change	Socially Responsible Business	Not mentioned above

Please select all that apply.

Please specify any issue areas not mentioned above

What are your organization's primary strategies?

Communication/Public Education	Leadership Development/Capacity Building	Policy Development/Advocacy
Direct Service	Legal	Research
Grassroots/Community Organizing	Philanthropy	Not mentioned above

Please select all that apply.

Please specify any organizational strategies not mentioned above

What languages, other than English, does your organization use in service of your community?

MandarinSpanish/Creole SpanishNot mentioned abovePlease select all that apply.

Please specify any languages not mentioned above

Additional Information

What best describes the geographic scope of the work you currently do?

Local	Regional: Multi-county
State	Regional: Multi-state
National	International
Not mentioned above

Please select all that apply.

Please specify

On what issues do you focus?

Arts/Culture	Environment/Sustainability	Spirituality/Faith
Civil/Human Rights	Immigration	Technology
Economic Issues	Media	Violence Prevention
Education/Youth	Reproductive Health, Rights, and Justice	Workers' Rights
Electoral Change	Socially Responsible Business	Not mentioned above

Please select all that apply.

Please specify any issue areas not mentioned above

What are your primary strategies?

Communication/Public Education	Leadership Development/Capacity Building	Policy Development/Advocacy
Direct Service	Legal	Research
Grassroots/Community Organizing	Philanthropy	Not mentioned above

Please select all that apply.

Please specify any organizational strategies not mentioned above

Lodging/Dietary Preferences

All of our trainings are shared occupancy. Rockwood typically arranges rooming based on the age and gender of participants. If you would like us to consider any particular preferences or needs when assigning rooms, please specify below.

Birthdate

Gender

Female	Transgender Man	Not mentioned above
Male	Transgender Woman

Please select any/all choices with which you identify.

Please specify

Preferred Gender of Roommate(s)

Female	Transgender Man	No preference
Male	Transgender Woman

Please select all that apply.

Please list any special needs (dietary, allergies, mobility, etc)

Other Information (optional)

The mission of the Rockwood Leadership Institute is to build a network of skilled and collaborative nonprofit leaders. The following questions are designed to help us understand our community better so that we can design and deliver programs that support you and others in this field. All information is kept strictly confidential. No data points will be used individually, rather they will be aggregated for internal use only. Thank you for your help.

Race/Ethnicity

African/African American/Black	Latino/Hispanic	Pacific Islander
Arab/Arab American/Middle Eastern	Mixed/Multiracial	White/European American (not Hispanic)
Asian/Asian American	Native American/Native Alaskan	Not mentioned above

Please select any/all choices with which you identify.

Please specify

Sexual Orientation

Bisexual	Heterosexual/Straight	Queer
Gay	Lesbian	Not mentioned above

Please select any/all choices with which you identify.

Please specify

Spiritual practice

I have read and agree to Rockwood's transfer/cancellation policy.

Please click "Next" to review your application. Afterwards, click "Confirm" to send us your application. You will receive an update on the status of your application in 10-12 business days.

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Contact Information