Please use the registration form below to apply for the Leadership Accelerator Program running from January – April 2023. Please review the Program Calendar before submitting your registration.

In addition to completing this application, please:

1. Upload a professional headshot to our system here (If you have any issues uploading your image, please reach out to Jennifer Stevens at

2. Have your supervisor complete the Supervisor Commitment Form

You must complete the entire form in one session. Before beginning the form, we recommend you gather the information you need and compose the short answer responses in another word processor (you can copy and paste into the form).

If you encounter any problems submitting this form, please contact us via email

  • Name

  • Work

  • Please indicate the industry/segment you work in.
  • Personal

  • If selected for this program, we'll order a permanent nametag for you. The nametag will include your preferred first name as well as your last name.
  • If none, type "none."
  • Nursing mothers, wheelchair accessibility, etc. If none, type "none."
  • If selected for this program, we'll list your name in a press release. Please indicate how you would to see your name appear, including any post-nominal letters. (Please note that the Leadership Louisville Center adheres to AP style and may edit your entry.)
  • Demographics

    Diversity is an important part of our mission. In an effort to understand our registrants and ensure all populations are served, we have a few questions we'd like to ask. Please know that:

    - This information is used to collect demographic data on our registrants.
    - The information will not be used for a discriminatory purpose.
    - Only Leadership Louisville Center staff will have access to this information.
    - Your responses will be kept private and secure.

  • If you provide pronouns, they will appear on your permanent nametag. For example: "She/her/hers", "He/him/his", "They/them", "Ze/zir/zirs"
  • Affinity Group Specific Questions

    There are different terms at different companies for affinity groups, employee resource groups, business resource groups, etc. For purposes of this form, we will refer to them as “affinity groups” for short.
  • Please enter a whole number.
  • Please enter a whole number.
  • Program Commitments

  • Important - Please Read!

    After clicking the Submit button, it may take a few moments to process your application. Once your application is submitted successfully, you will see a confirmation message and receive an email within five minutes that contains all the information you submitted. If you have any problem with this application, contact Christin Head at (502) 561-0458.

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