Certificate in Community Development Application
* Denotes Required Field.
NAME
*
Course Options
August 2020
*
Introduction to Community Change * (taught alternating semesters)
Bottom Up Economics
21st Century Communications
Monitoring and Evaluation
February 2021
*
Going to Scale (taught alternating semesters)
*
Strategic Resource Mapping
Sustainable Communities
Nonprofit Management
PERMANENT STREET ADDRESS
CITY
STATE
ZIP
*
COUNTRY
HOME PHONE
CELL PHONE
*
EMAIL
*
DATE OF BIRTH
*
GENDER
Male
Female
U.S. CITIZEN
Yes
No
ETHNICITY
Non-Resident
White / Caucasian
Black / African America
American Indian / Alaska Native
Hispanic / Latino
Asian
Native Hawaiian / Other Pacific Islander
Other
VETERAN STATUS
Not a U.S. Veteran
U.S. Veteran
U.S.Disabled Veteran
Active Reserve
Inactive Reserve
ARE YOU AN AMERICORPS MEMBER ?
Yes
No
ARE YOU A PEACE CORPS VOLUNTEER ?
Yes
No
ARE YOU ASSOCIATED IN ANY WAY WITH A SCOUTING ORGANIZATION?
Yes
No
DATE
Declaration
*
I agree that by Checking this box and submitting this form that all information is accurate to the best of my knowledge.
Submit
