Responsible Business Leaders Application

Contact Information *

First Name Last Name Email

Workplace *

Company or Organization Name Title / Role / Profession

Which of the following best describes your professional experience? *

Early career (1 - 7 years professional experience)
Advancing career (8-15 years professional experience)
Established career (15+ years professional experience)

Your gender *

Female
Male
Other

I identify my gender as

Your ethnicity (select all that apply) *

Asian
Black/African American
Hispanic/Latino/a
Middle Eastern
Native American
Pacific Islander
White/Caucasian
Mixed race
Other (please specify)

Other ethnicity

Voluntary Self-Identification

United Way is committed to the diversity and inclusion of individuals with disabilities. If you would like, please let us know whether you identify as having a disability. You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. (Note: a list of possible disabilities is listed at the end of this application)

Yes, I have a disability or history/record of one
No, I do not have a disability or history/record of one
I do not wish to answer

Please tell us a little more about your previous experience and interest in this program.

Why are you interested in joining the Responsible Business Leaders program? *

How would you describe your company’s current approach to social responsibility and where do you see the greatest opportunities for delivering on responsible leadership in the future? *

How will you leverage your experiences and leadership to support the learning experience of your peers in this group? *

What role do you think the business community could play in advancing racial equity for marginalized communities in our Chicagoland region? *

How did you hear about this opportunity?

Please upload your resume here. *

Accepted file types: pdf, doc, Max. file size: 256 MB.

Acknowledgement of fee structure and application submission *

In submitting this application, I acknowledge the program’s cost of $750, and if selected, agree to secure this funding either through corporate sponsorship or personal contribution.

Ongoing Communications

I’d like to stay connected to news and updates from United Way of Metro Chicago.
I’d like to stay connected to news and updates from the Baumhart Center.

Voluntary Self-Identification Disabilities

Disabilities include but are not limited to: Autism, Autoimmune disorder (for example, lupus, fibromyalgia, rheumatoid arthritis, or HIV/AIDS), Blind or low vision, Cancer, Cardiovascular or heart disease, Celiac disease, Cerebral palsy, Deaf or hard of hearing, Depression or anxiety, Diabetes, Epilepsy, Gastrointestinal disorders (for example, Crohn's Disease, or irritable bowel syndrome), Intellectual disability, Missing limbs or partially missing limbs, Nervous system condition (for example, migraine headaches, Parkinson’s disease, or Multiple sclerosis (MS)), Psychiatric condition (for example, bipolar disorder, schizophrenia, PTSD, or major depression)

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Voluntary Self-Identification Disabilities

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