Application

Consortium for Social Enterprise Effectiveness

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First Name*

Last Name*

Nickname

Job Title

Company*

Is the address below your:*

Home Address

Work Address

Address

Apartment #

State*

City*

Zip Code

Daytime Phone*

Cell Phone

Email*

Website

How did you hear about this program (mark all that apply):

Other Sources:

1. What interests you most about this program? What are some of the main reasons you would like to attend, and/or what do you hope to gain from attending this program?*

2. To help us better understand your organization, provide a brief description of its core mission and/or goals.*

3. How would you describe your organization's workforce? For example, approximately how many paid employees vs. volunteers do you have, etc. [Note: Your response does not have to be exact; just provide enough information to help us understand the general size and makeup of the organization.]*

4. How would you describe your role in the organization? For example: To whom do you report? Who reports to you? Do you have regular contact with your organization's board of directors, etc.?*

5. Describe one or more specific, board-level / board-worthy issue or problem that you need to tackle in the coming year. For example: issues that are of critical importance to the future of your organization, issues over which you have real influence or control and will be held accountable for addressing, etc.*

NOTE:

Competitive and need-based scholarships are available to cover up to half the tuition costs. Scholarship requests are reviewed on a case by case basis by the program director, Dr. Alex Miller. The scholarships are competitive, so early submission is recommended. If you wish to apply for a scholarship to the program, please complete section #6.

6. Include an explanation of your need and the amount of tuition you will be able to fund and the amount of scholarship you therefore are requesting.

ATTENDANCE POLICY:

Successful completion of the CSEE program requires your commitment to attend all scheduled class sessions and complete all assignments on time. Unforseen emergencies do happen, and for this reason, students are allowed to mess 1/2 day during the 10 month program. Classes are videotaped for these purposes. If a student misses more than the allowed 1/2 day, they must then attend the missed portions of the residency period(s) with the next year’s class in order to earn the course certificate. By checking the box below demonstrates my understanding of and commitment to the CSEE attendance policy.

I Agree*

I Agree

Phone

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