11. Specifically, what do you hope to gain by participating in Momentum?
a. Momentum may pair you with an experienced local mentor. What would you most like to
achieve as a result of having a mentor assist you with personal/professional growth?
b. Have you had the opportunity to mentor others? If so how?
c. An alumnae requirement for Momentum graduates is to become a mentor to a woman or
girl. What thoughts do you have about what you might expect to gi
such a commitment?
13. What leadership assessment instruments have you completed in the last five years?
______ Dimensions of Leadership Profile DISC
Emotional Conflict Inventory (ECI)
California Psychological Inventory ___
A 360 feedback instrument What?
III. Please check appropriate space
If selected as a participant:
My organization will cover my $4,500 tuition in full.
I will assume responsibility for my tuition in full.
I would need a scholarship in order to attend this program. (Momentum will contact
you for specifics.)
IV. Please initial before each statement
I certify that all statements made in this application are true, complete and correct to the best of
my knowledge and are made i
n good faith. I know and understand that all information may be
verified. If selected, I have my company or organization’s support for my participation, if
applicable, and I will attend retreat and all sessions in their entirety. See Session Dates below.