Speaking From the Heart

Thank you for your interest in this program.

Please answer the questions below so I can learn more about you and what interests you about program.

I look forward to being in touch!

Name

First Name

Last Name

Please tell me about the work you do. I'd like to get a sense of how you might apply the learning from this program (i.e. name of company, job role, related responsibilities).

What are some of the challenges you face in speaking up or giving feedback at work? What makes this hard, at times, for you?

Do you have a feedback model you use? If so, what is it?

What do you most hope to gain from participating in this program? What caught your attention? What are you most looking forward to?

What other questions do you have for me?

How did you hear about this program? If someone referred you, please include their name so I can thank them for the referral.