Applicant's Name: _______________________________________________SS/ID#________________________

Home Phone #:_________________ Work Phone #:____________________

Present Position _________________________________________________

Describe your work experience and volunteer work relevant to graduate study in public affairs:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

List any course work since undergraduate school that would be of relevance to the certificate:
 
 
 
 
 
 
 
 
 

Describe your interest in the Nonprofit Management Certificate and how you believe a certificate will help your agency, and/or advance your career:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Applicant's signature______________________________________________________Date__________________

Please return to:

Dr. Ken Klase, Political Science, UNCG, P.O. Box 26170, Greensboro, NC 27402-6170