LeadFit Application Form

Candidate Information

First Name^*

required

Last Name^*

required

Employer Name^*

required

Address^*

required

Apt., Suite, Etc.

City^*

required

State^*

required

Zip^*

required

Address is:^*

required

Home

Work

Email^*

required

Phone^*

required

Are you a licensed CPA?^*

required

Yes

If you hold a supervisory position, how many people do you supervise?

Shirt Size^*

required

Men's Large

Men's Small

Men's Medium

Men's X-Large

Women's Large

Women's Small

Women's Medium

Women's X-Large

Please note any dietary restrictions:

Why do you want to attend LeadFit?^*

required

Please attach a current resume/biographical sketch:^*

required

Please include your experience in accounting and work history for the past five years.

Please attach a recent photograph:^*

required

Mentor Information

Your LeadFit mentor is be an important part of your LeadFit experience—and a strong advocate for your growth throughout the program. If you have not already been asked by a mentor to participate, we recommend selecting a mentor from within your organization who supports the purpose of LeadFit and is positioned to encourage and reinforce your development along the way. Your mentor will be invited to the final graduation ceremony to share insights and help you transition your learning into real world experiences.

Mentor Name^*

required

Mentor Company Name^*

required

Mentor Email Address^*

required

Mentor Phone^*

required

Billing Contact

Billing Contact Name^*

required

Billing Contact Email Address^*

required

Billing contact street address^*

required

Apt., Suite, Etc.

City^*

required

State^*

required

Zip^*

required

Any questions or additional information you would like to share with the COCPA?

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LeadFit Candidate Application

Candidate Information

Mentor Information

Billing Contact