Management Concepts Training Application Form

To be considered for the training program please complete the application form in its entirety. This training opportunity is at no cost to participants and is being offered by the VRTAC-QM in partnership with Management Concepts. Please ensure that as an applicant you are able to dedicate the needed time to complete the training as outlined in the program description.

Items with an asterisk (*) are required to submit the application.

Personal Information

First Name:*

Middle Initial

Last Name:*

Email Address:*

Back-up Email:

Preferred Pronouns:

Phone Number (Office):

Phone Number (Cell/Personal):

Please list any needed accommodations to assist with successful completion of this training:

Agency Information

Agency Name:*

Agency Location (City):

Agency Location (State)*

Zip Code:

Position title:*

Screening Questions

Do you intend to complete the certificate program?:*

Yes

If no, what courses do you intend to take?

Do you have management support to complete this certificate/training process as required?:*

Yes

If no, how do you intend to fully participate in the courses?

Do your duties include managing aspects of the VR grant within your agency?:*

Yes

If no, what are you primary responsibilities?

Please include contact information for your direct supervisor to verify their support for your participation in this training. Verification of support will be obtained to ensure dedication and participation to the program

Supervisor Email:

Phone Number:

Do you have:

Technology adequate to participate in online course:*

Yes

Access to the Internet and the learning platform:*

Yes

Time to complete the online courses:*

Yes

What is your intended time frame for completion of the certificate or the courses you have selected?:*

What do you hope to gain from this certificate training program and how do you intend to apply the information within your current role?:*

I certify that all of the above information, to the best of my knowledge, is accurate. By signing this form, I understand that I am applying to a grant funded training certificate program and that if I am selected to participate, I am to give my full attention and participation. I certify that this content area is relevant to my current field of employment or area of study, and I intend to use the information present through the certificate course to enhance my knowledge and improve quality services. (Click on the box below to sign)

Type your name to sign:*

Date:*