Surge Alumni Programming + Opportunities
Your Information
Alum or Guest?
Alum
Staff/Invited Guest
First Name
Last Name
Pronouns
Type your preference to find it in the list or to enter it directly.
Cohort
Primary Email
Mobile Phone
Opportunity Summary
Select the event you'd like to attend:
Event Description (Read-only)
Opportunity RSVP Details
Organization/District:
What is your title/role?
What state do you reside in?
Are you a sitting K-12 education leader? (ie - Superintendent, CAO, district leader, Principal, leading innovation across a district/school). If no, please consider who else from your network you might nominate for this K-12 educator award.
Yes
No
Which type of scholarship are you interested in?
Registration Only
Registration + Hotel
Please note that opportunities for
Registration + Hotel
scholarships are limited, so select
Registration Only
as well if you would be interested in that option when hotel scholarships are no longer available.
What is your Assistant's name and email, if applicable?
Opportunity RSVP Details
Why are you interested in this opportunity? How is this relevant to your leadership journey at this point in time?
Which of the following apply to you? (Select all.)
I am a first-time attendee of this conference
I am presenting at this conference
I have current financial barriers such as unemployment
I have added costs to attend like traveling in from outside of the conference area
I am an engaged Surge alum (ie, an IMPACT Community member, participant of recent Annual Alumni Surveys)
None of the above
Conference sponsorships only cover the event registration fee, unless otherwise noted. Conference scholarships are limited and I am requesting one knowing that I am fully available to attend. If I am awarded a sponsorship and I accept, but am later unable to attend, I may be responsible for any late cancellation fees associated with this event.
Yes, I understand
Please note that opportunities for scholarships are very limited. Please only submit an application if you are certain you can fully participate in the conference.
Opportunity RSVP Details
Venture Name
(if applicable)
Venture Type
(if applicable)
Nonprofit
For-profit
Other
if other please list
We are looking to leverage current challenges regarding your venture’s sustainability. Please share a situation you are currently experiencing as a founder that you would be willing to discuss in a group setting.
(optional)
Opportunity RSVP Details
How did you hear about this event?
Please select...
Alumni Quarterly Newsletter
Other Surge Email
Social Media
Fellow Surge Sibling
Alumni Biweekly Email Updates
Other
If you selected Other, please share how you heard about this event
What days are you attending?
Please select...
Friday and Saturday
Friday only
Saturday only
I will not be attending
Please list any dietary restrictions, allergies, or accommodations.
What is your venture name?
What is your role at this venture?
What is your venture's mission statement?
Venture website or relevant link:
What are the top questions (up to three) you have for experienced entrepreneurs, founders, and funders regarding growing your venture? (Ex: What is your biggest learning regarding customer acquisition and retention? What do you know about the current funding landscape for my industry that I should know?)
Contact Information