2015 Women of the Channel
The person filling out this form will be CRN/The Channel Company's primary contact should any questions arise.Please enter your contact information below.
YourFirst Name*: ______
Last Name*: ______
Your Title*: ______
Your Organization*: ______
Email Address*: ______
Phone Number*: ______
Extension, if applicable: ______
Name of person that you will be applying for*: ______
Applicant Information
First Name*: ______
Last Name*: ______
Company*: ______
Title*: ______
Email Address*: ______
Phone Number*: ______
Extension, if applicable: ______
City*: ______
State*: ______
Company URL*: ______
Years In Current Position*: ______
Years In The Channel*: ______
How have you personally helped advance your company's channel business over the past year?(200 words max)*
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What are your goals for your company's channel business over the next year?(100 words max)*
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What programs/initiatives does your company offer to support women in the workplace:(100 words max)*
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Female role model:(100 words max)*
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What advice would you give to young women aspiring to succeed in the workplace? (100 words max)*
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What is your favorite novel and why is it meaningful to you?(100 words max)*
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What tips do you have on how to find work/life balance?(100 words max)
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Please Answer 'Yes' or 'No' to the following questions:*
Yes / NoI live within the limits of a major city / ( ) / ( )
I have lived in a country other than the U.S. for at least 12 months / ( ) / ( )
I am fluent in a language other than English / ( ) / ( )
I use Twitter / ( ) / ( )
I use Instagram / ( ) / ( )
I use Facebook / ( ) / ( )
I use LinkedIn / ( ) / ( )
I use Vine / ( ) / ( )
I have an advanced degree (a degree higher than a bachelor's degree) / ( ) / ( )
I have an MBA / ( ) / ( )
I have worked for a solution provider organization / ( ) / ( )
I have a mentor / ( ) / ( )
I am a mentor / ( ) / ( )
I am a tech geek / ( ) / ( )
I use more than 3 mobile devices / ( ) / ( )
I have a pet / ( ) / ( )
I love to sing / ( ) / ( )
I am athletic / ( ) / ( )
I know how to fly a plane / ( ) / ( )
I watch too much TV / ( ) / ( )