Certificate in Community Development Application (A)
* Denotes Required Field.
FAMILY NAME/SURNAME
*
GIVEN NAME
*
Course Options
Note : Introduction to Community Change and Taking Impact to Scale are required courses. You can choose any two other courses as suits your interests
FEBRUARY 2021
*
Taking Impact to Scale *
Social Research for Social Change
Leadership in Community Building
AUGUST 2021
*
Introduction to Community Change *
Bottom Up Economics
21st Century Communications
Monitoring and Evaluation
Strategic Resource Mapping
Nonprofit Management
PERMANENT STREET ADDRESS
CITY
*
STATE
*
ZIP
COUNTRY
*
HOME PHONE
CELL PHONE
*
EMAIL
*
DATE OF BIRTH
*
GENDER
Male
Female
I prefer not to answer
U.S. CITIZEN / US RESIDENT
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
DATE
Declaration
*
I agree that by Checking this box and submitting this form that all information is accurate to the best of my knowledge.
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