Application for the WorldBlu Freedom-Centered Leader™


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Application for the WorldBlu Freedom-Centered Leader™

Certification Program

…………………………………………………………………………………………………….…
NAME:
PRIMARY EMAIL:
ALTERNATE EMAIL:
GENDER (PLEASE CHECK ONE):

__ FEMALE

__ MALE
DATE OF BIRTH (MM/DD/YYYY):
HOME ADDRESS:
CITY:
STATE (IF APPLICABLE):
COUNTRY:
POSTAL CODE:
PHONE 1 (mobile):
PHONE 2 (work):
SKYPE:
TWITTER:
T-SHIRT SIZE (please select one):
___ Extra Small (XS)

___ Small (S)

___ Medium (M)

___ Large (L)

___ Extra Large (XL)

___ Other (please specify)


ALTERNATE POINT OF CONTACT (In case we need to reach you during the duration of the program and aren’t able to, we would reach out to this person instead.):
RELATION TO THE CONTACT:
CONTACT’S EMAIL:
CONTACT’S MAIN PHONE:

COMPANY NAME:
COMPANY ADDRESS:
COMPANY PHONE:
WEBSITE:
POSITION/TITLE:
YEARS IN POSITION:

PLEASE TELL US ABOUT YOURSELF
We take this portion of the application very seriously. Please take the time to answer the questions thoughtfully, with enough detail to help us understand who you are. Please keep your answers to 150 words or less per response.

1. Why do you want to earn your Freedom-Centered Leader™ certification?

2. Why should we accept you into this highly competitive and select program?

3. Becoming a certified Freedom-Centered Leader requires a readiness of time, resources, head and heart, and a willingness to think deeply, self-reflect, and grow. Why do you feel you are ready to go on this transformational leadership journey at this time?

4. It may take up to 2-3 years to earn all of your WorldBlu Principle Badges™ and your ultimate, Freedom-Centered Leader badge. The process will take patience, perseverance, and self-discipline. Please share an example of how you committed to something and saw it through to completion, even when it may have taken a long time or been quite challenging.

5. What are three things you hope to improve about yourself by completing the Freedom-Centered Leaders badge program?
1.
2.
3.

6. What are three ways you plan to use what you learn by earning your Freedom-Centered Leader badge?
1.
2.
3.
7. What are three things you hope to give back to the larger WorldBlu community as a result of earning your Freedom-Centered Leader badge?
1.
2.
3.
8. Please check all that apply:
__ I have the time to commit to earning my Freedom-Centered Leader

badge. I understand that the entire process may take 2-3 years,

depending on how quickly I choose to move through the material.
__ I have the financial, emotional, spiritual and intellectual resources to

commit towards earning my Freedom-Centered Leader badge.

__ I have at least one person in my life that is willing to support me on this

journey.
__ I am choosing to do this program willingly and of my own choice. I have

not been forced to do the program by my employer or anyone else.
__ I have an open mind and an open heart to learning about and practicing

true freedom-centered leadership.
__ I am committed to earning ALL 10 WorldBlu Principle Badges and the

final badge, the Freedom-Centered Leader badge.
___ I understand that because the fee for the program is a one-time, lifetime guaranteed fee, even if there is a reason to delay starting the program, I will still have an unlimited amount of time to complete it. For this reason, I understand that WorldBlu will not offer any refunds once I have committed to the program, nor is it transferable.
__ I understand that if I am receiving a scholarship for this program that I must complete the program in three years or replay the scholarship.

9. Is there anything else you’d like to tell us about yourself or why you want to be a part of this program?


YOUR BIO + PHOTO

Please share your bio and a photo with us here. (Limit 150 words)

PERSONAL REFERENECES

Please provide three references.
Reference 1:

Title of Reference:

Relationship:

Email:

Reference 2:

Title of Reference:

Relationship:

Email:

PAYMENT

The fee for the Freedom-Centered CEO badge program is $7,500 USD and is due within two weeks of acceptance into the program. Monthly payment plans are also available.
If accepted into the program, please indicate how you would like to pay.
___ I will pay via check. Please email me an invoice.
___ I will pay via credit card. Please send me the link to do so.
___ I will pay via wire. Please send me WorldBlu’s wire details.


YOUR COMMITTMENT
I confirm that the information I have provided on this application form is (to the best of my knowledge) true, accurate, current and complete, and I agree to notify WorldBlu promptly if any information contained on this application form should change.

I understand that all details in this application are for internal review and communication purposes only. WorldBlu will never sell your information to a third party.
Lastly, I am fully committed to the successful completion of the WorldBlu

Freedom-Centered Leader program.
Please check or sign below to confirm acceptance of these statements:

SIGNATURE: DATE:

PLEASE PRINT NAME:


SUBMITTING YOUR APPLICATION
Thank you so much for applying for the Freedom-Centered Leader badge program. Please submit your completed application to:
Miranda Ash at miranda@worldblu.com
Once we receive your application you will hear back from us within 10 business days.

FURTHER QUESTIONS?
Please contact:

Miranda Ash

+ 1 718 593 4172 (US)

+ 44 7813 798083 (UK)

miranda@worldblu.com

BONUS MATERIALS

Below is the WorldBlu Freedom-Centered Leader Self-Assessment™.
We encourage you to print it and take it to get a sense of where you are on the continuum of being a fear-based or freedom-centered leader.
You do not need to share your results with WorldBlu, rather they are for your self-growth and reflection.
We hope this is a helpful tool for your continued learning journey.




© 2014 WorldBlu

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