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Full Name
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Age Range
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18–24
25–29
30–34
35–39
40–44
45–49
50–54
55–64
65+
Email
*
Phone
*
Gender
*
Male
Female
Other
If you selected other, please specify how you identify.
What industry do you work in?
*
What is your job title?
*
Select the option that most applies to you.
*
I am a business owner
I am in paid employment
I am both
Do you identify as a Black professional living and working in Manitoba?
*
Yes
No
Are you currently within your first 2 years of your FIRST EVER management, supervisory, or people-leadership role OR actively building a team as a founder or business owner?
*
Yes
No
Are you currently responsible for leading, influencing, or managing other people, formally or informally?
*
Yes, I am CURRENTLY responsible for leading, influencing, or managing other people, formally or informally
Yes, I am INTERESTED but never directly led or managed others in an official capacity
No, I am NOT currently responsible for or interested in leading, influencing, or managing other people, formally or informally?
Are you anticipating or currently facing real leadership challenges that you would like to work through during the 10‑week program?
*
Yes
No
If yes, briefly name the leadership challenges.
*
Can you realistically commit to at least 1 hour during the work week and 2.5 hours on weekends for the full 10‑week program?
*
Yes
No
Can you attend the live virtual sessions and participate actively, rather than passively?
*
Yes
No
Are you open to receiving feedback, engaging in reflection, and changing how you lead—not just learning new ideas?
*
Yes
No
Are you willing to apply what you learn right away in your workplace or business?
*
Yes
No
What are your leadership goals? What transformation do you most want to see in yourself—and in your team or organization? Please be as specific as possible.
*
If selected, are you ready to show up consistently and fully for yourself and for the cohort?
*
Yes
No
Submit
Black Leadership Launchpad
Application Form
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