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* 1. Full Name

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* 2. Title

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* 3. Company

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* 4. How did you hear about iCSR?

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* 5. Mailing Address (street)

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* 6. Mailing Address (City, State, ZIP)

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* 7. Email

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* 8. Phone Number

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* 9. LinkedIn profile url

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* 10. Will you be able to attend the course via Zoom video? 

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* 11. Please enter a brief bio including any relevant professional experience and achievements that support your participation in iCSR Class of 2021.

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* 12. What is your primary interest in attending iCSR?

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* 13. In which curriculum topic are you most interested?

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* 14. Your Billing Preference

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* 15. Your Tuition Amount

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* 16. Supervisor Approval

Each application must be approved by the applicant’s supervisor. Please have your supervisor send an email with “iCSR Approval – YOUR NAME” in the subject line to Caroline Healey at healey@WashingtonGrantmakers.org. The email should include their full contact information and a short note communicating they read this section of the application.  By submitting their email, the supervisor affirms that the applicant a) is a current employee in good standing, and b) if accepted, the applicant will be granted the time to fully participate in the program. Your application is not considered complete unless we receive your supervisor's approval.

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* 17. Applicant Agreement

I agree to be an active participant in the Institute for Corporate Social Responsibility, including participating in all online sessions and related activities, reviewing course materials in advance, actively participating in video discussions and group work, and purposefully applying my learnings to my work as a professional. Please enter your name below to sign.

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