Enrollment Application

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Enrollment Application Application may also be completed online at www.nmc-pb.org Name: ________________________________________________________________________________ First

Middle

Last

Do you go by something other than what you listed as your first name, if so what is it?: __________________ Company Name: ________________________________________________________________________ Sponsor (if different from employer): ________________________________________________________ Home Address: _________________________________________________________________________ Number

Street

City

Zip Code

Business Address: _______________________________________________________________________ Number

Street

City

Zip Code

Home Phone: ___________________________ Business Phone: __________________________________ Cell Phone: ______________________________ What email address would you prefer to receive communication from then Nonprofit Management Center: Email: ______________________________________________________________________ Do you prefer to have postal mail delivered to your home or work address?

____ Work ____ Home

Length of Residence in the Permian Basin (cumulative): __________________________________________ If Married, Spouse’s Name: ________________________________________________________________ Hobbies: ______________________________________________________________________________ Breakfast is provided at each session, do you have any food allergies we should be aware of? ___ Yes ___ No If yes, please elaborate: ____________________________________________________________

Employment/Occupation

Account for all periods including military active duty. Employer

Title or Responsibility

Dates (From-To)

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Education Begin with High School, then College(s), Graduate Schools, Business or Trade Schools and/or other Specialized Training. Name and Location of School

Dates (From-To)

Degree/Certificate

Area of Interest

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Community Activities List key community, civic, professional, business, religious, social, and other organizations of which you have been a member within the past five years. Be sure to include any nonprofit boards you are currently serving on. (Please note current service will not count as the one year board service participants commit to following the Generations program.) Organization

Positions Held

Approximate Dates of Membership

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Special Honors or Awards for Leadership Activities: _____________________________________________ ______________________________________________________________________________________ What have you accomplished in these activities that you think is important? ______________________________________________________________________________________ ______________________________________________________________________________________ If not already listed above, list the positions of leadership you have held over the past ten years including past board membership. ______________________________________________________________________________________ ______________________________________________________________________________________

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Commitment Generations is a learning experience and requires the following commitments on the part of the participant: 1. Attendance at all 8 sessions is required; therefore, no absences are authorized. Even though emergencies do arise, any participant missing any or all of more than 2 sessions, for whatever reason, shall be automatically dropped from the program. 2. A full session shall commence at 8:15 am and end at 11:45 am. 3. The course work for Generations is designed to prepare community volunteers to move into service at local nonprofit organizations. The employer as well as the employee should understand that a commitment has been made to actively participate in the course work and for a minimum of one year in the work of their chosen organization following placement. 4. The Nonprofit Management Center (NMC) staff facilitates the matching of the participant with a local organization. Participants are discouraged from finding an organization or approaching a nonprofit on your own. Participants who currently serve on a nonprofit board and/or participants who agree to board service not facilitated through NMC staff will be required to serve on an additional board. A certificate will be awarded to those who complete the program by fulfilling the above commitments. I understand the above commitments and agree to be bound by them in signing this application. _________________ Date

_____________________________________________ Applicant’s Signature

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Employer Commitment This application has the approval of this firm and the applicant has our full support which includes the time required to participate in the Generations program and nonprofit organization following graduation. Please indicate if self-employed. _____________________________________________ Print Name

_____________________________________________ Signature

_____________________________________________ Title

Company will be billed tuition at time of acceptance; please do not include check with application.

Please Complete Application and Return by December 21, 2017. Please return to:

Generations Nonprofit Management Center 3500 North A Street, Suite 2300 Midland, Tx 79705

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