DEI Change Agent Certification Program Application

Thank you for your interest in the DEI Change Agent Certification program! Brevity & Wit reviews and accepts applications on a rolling basis.

Note: Successful organizational change initiatives require senior leader buy-in. Brevity & Wit strongly recommends sharing your participation in this program with senior leaders.

If you have questions, please review the program FAQ or email paige@brevityandwit.com.

First name *

Last name *

Email *

Phone number *

Time-zone *

Organization Affiliation *

Title/Role(s) *

If you lead a volunteer group (e.g. DEI Council/Committee, ERG/Affinity Group) please share this as well.

What are the ways you lead or influence culture change in your current role(s)? *

What kind of experience do you have leading culture change in complex systems? *

Why are you interested in participating in this program? *

What do you hope to be able to do after the program?

What skills or knowledge are you interested in learning?

Your answers will help us tailor course curriculum.

Who should we send the invoice to? *

Please share the person's name, title, email address and phone number.

Note: Program participation requires payment before the program start date. If your organization has specific invoicing requests or requirements, please share them above.

Referral

If someone referred you to this program, please write their name here so we can thank them!

Do you require any accommodations to participate?

Please tell us about your accessibility needs and we will do what we can to meet those needs! If there anything else that you would like to share with Brevity & Wit in advance that would allow you to thrive in this program, please let us know.

Final Questions

Brevity & Wit would like to collect the demographic information of program applicants to consider what barriers to access we may need to address in the future. While the identity-based questions below help us advance our commitment to equity, they are completely optional and are not used as criteria for participant selection at this time.

You are encouraged to share as much about your intersecting identities as you feel comfortable.

Age

Gender Identity

Race

Ethnicity

Education level

Disability status

Sexual orientation

What other dimensions of diversity are important for you to share and/or are important for Brevity & Wit to track?