Whitworth Learn Powered by Innovia

Name *

First

Last

Number Budget leadership

Organization Name *

Title/Position *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Organization Mission *

Number of Employees

Annual Budget

Professional Background *

Please tell us how long you have been with the organization, your current roles and responsibilities, and your future aspirations within the organization.

Why are you interested in participating in this leadership certificate program? *

Scholarship Request Amount *

Innovia scholarships will fund up to 50% ($1,750) of the program fee. Please indicate how much you are requesting, and any additional information to help us understand your organization's need for assistance.