Center for Nonprofit Management, Kellogg School of Management

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NONPROFIT EXECUTIVE EDUCATION

Application Form

Please fill-out this form and click submit to complete. You will be contacted by our department to confirm that your registration has been received. If you have any questions please call 847-491-3415.

Name*:

Informal Name:

Position/Title:

Organization*:

Affiliation:

Address*:

*City:**	*State:**	*Zip:**

Phone*:

Fax:

E-mail*:

Industry:

	Arts/Culture
	Government
	Education
	Environment
	Healthcare/Health Services
	Social Services
	Other

Size of Organization

Annual Budget ($): (*REQUIRED)

Employees (FTE): (*REQUIRED)

Customers/Clients (#)

Does your organization have 501©3 status?

Yes	No

If no, what status do you have?

Title of Nonprofit Program Selected:

How did you hear about us?

Scholarships

Scholarships of up to 50% will be made available to organizations that need financial assistance to attend these courses. However, tuition should not be a barrier to participation in the class, so exceptions will be made on an as needed basis. Each student will need to apply for a scholarship. On occasion, interviews may be required.

If you are interested in receiving financial assistance to attend a course on either the Allen Center or the Chicago campus, please complete the following questions.

(1)Why will the class you selected be helpful to (a) you and (b) your organization at this point in time?

(2)What are your responsibilities within your organization?

(3)Are you a Kellogg School of Management graduate?

Yes	No

(4)What is your educational background?

Level of scholarship requested (up to 50%):

Rationale for percentage:

Scholar Grant Code:
*Please select only if you have been notified of recipient status

Approval:

Name of the Chief Executive Officer/Board Chairperson

Title:

As Chief Executive Officer/Board Chairperson, I approve this application.

Yes	No

Date

Payment:

The tuition for 2 1/2 day programs is 950.00. Payment must be received before the first day of class to attend program.

Cancellation Policy:
Participants must notify the program manager 5 business days in advance of program if they are unable to attend. Otherwise, participants will be charged 20% of stated tuition.

Make check payable to:
Kellogg School of Management
Center for Nonprofit Management
2001 Sheridan Road, Rm. 501
Evanston, IL 60208

For more information about our Nonprofit Executive Education programs please call 847-491-3415 or email us at nonprofit@kellogg.northwestern.edu