Leadership Institute Application Form

Template is used to gather information or receive information about applicants to a leadership institution.

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Leadership Institute Application

© CPA Firm Management Association
CPA Firm Management Association in partnership with Succession Institute will be launching the CPAFMA Leadership Institute in 2017. This program is built for real world challenges with a real world curriculum, designed exclusively for the Association and its membership.

This high impact program is focused on CPAFMA emerging and experienced firm leaders to enhance their key skills in firm management and develop them as leaders in the profession. This 4-day program is delivered in the following way and includes:

Days 1 and 2
Situational Leadership (SL): Foundational Principles for Managing and Leading Others
Communication, Assertiveness, Conflict Management, Negotiation and Managing Change

Days 3 and 4
Trends, Business Models, Governance, Accountability, Developing People and Pay

This program is being heavily subsidized by the CPA Firm Management Association as a benefit for those members interested in this level of personal development. The 2017 CPAFMA Leadership Institute is limited to 20 people.
APPLICANT INFORMATION
Name *
Title *
Firm *
Mailing Address *
City *
State/Province *
Postal Code *
Email address *
Phone number *
Years of Experience (Accounting) *
Years of Experience (Non-Accounting)
Managing Partner's Name *
Managing Partner's Email *
Has your firm agreed to support your participation in the CPAFMA Leadership Institute?

Yes No
Are you a current member of the CPA Firm Management Association?

Yes No
You must be a member of the CPA Firm Management Association to apply for and be chosen to participate in the CPAFMA Leadership Institute. If you are not currently with a CPAFMA member firm and wish to apply, you may join online at www.cpafma.org.
Please list all CPAFMA national or chapter positions or initiatives you currently or have previously supported:
Please list leadership roles you hold or have held inside the accounting profession or with any community or volunteer organizations and provide a brief description of your responsibilities with such roles:
Please attach a personal statement (approximately 300-500 words) about why you want to be a participant in the CPAFMA Leadership Institute and how participation will help you fulfill your leadership potential in the community in which you work, live, and serve, especially in the accounting profession.
Personal Statement
Please list two persons with knowledge of your attributes as a leader by name, address, phone number and/or email address:
Name #1 *
Email #1
Telephone #1

Address #1

Street Address
Street Address Line 2
City	State
Zip Code	Country

Name #2 *
Email #2
Telephone #2

Address #2

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Please attach two (2) letters of reference. Please include how the reference knows the applicant; why the reference believes the applicant will benefit from the CPAFMA Leadership Institute; and what the reference believes the applicant will contribute to the CPAFMA Leadership Institute.
Reference Letter #1
Reference Letter #2
Please attach a current resume.
Resume
The CPAFMA Leadership Institute is an interactive learning series, and provides the greatest benefit to the participant through attendance and active involvement in the planned sessions. The applicant's commitment to attending and participating in the class also benefits the other class members and supports a more effective learning environment. Each applicant that is selected is asked to commit to attending every scheduled session. The dates for the Class of 2017 sessions are listed below:

June 19, 2017 | 12 PM - 5 PM (Fort Worth, Texas)
June 19, 2017 | 6 PM - 9 PM (Fort Worth, Texas)
June 20, 2017 | 8 AM - 4 PM (Fort Worth, Texas)
November 7, 2017 | 8 AM - 5 PM (Chicago, Illinois)
November 8, 2017 | 7 AM - 4 PM (Chicago, Illinois)

The cost of the CPAFMA Leadership Institute is $500 plus registration and expenses associated with the CPAFMA 2017 National Practice Management Conference, June 20-23, 2017 in Fort Worth, Texas.

By signing below, the applicant agrees, if selected, to be a candidate in the Class of 2017 CPA Firm Management Association's Leadership Institute, to attend each of the sessions in their entirety. The applicant further agrees that after his/her graduation from the CPAFMA Leadership Institute to commit to maintaining membership and providing active service in the CPA Firm Management Association for at least three (3) years, to maintain connections with other Leadership Institute class members, and to help the CPAFMA identify future qualified Leadership Institute class applicants.
Signature *

Clear
You will receive notification by email upon receipt of the application.

Applications are due by December 31, 2016.
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