Designed for those who hold leadership positions in organizations, military, public/private sector, and academies; as well as city managers/assistants not ready to be credentialed but looking for their next challenge. You must have JavaScript enabled to use this form. Full Name Date of Birth Job Title Organization Office Street Address State Office Email Home Email ICMA Member yes no Please contact me via: telephone email At my: office home I work in the checked ICMA region SE MP MW NE WC Preferred Mentor Do you have a preferred mentor? If so, who? (Must be a credentialed manager) Commitment Signature Commitment Signature Endorsement I support participation in the Mid Career Manager’s program. Name Job Title Organization Office Street Address Description of your responsibilities Brief description of your organization (number of employees, annual operating budget, function or service provided, etc.) List of professional honors, awards, or publications; professional or volunteer activities What will you and your organization gain from your participation in ICMA University Mid Career Managers Leadership Program? Submit Leave this field blank
