Bank Compliance School Application

June 23-27, 2025 ~ Kearney, NE

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* 1. Enter your Contact Information

Full Name (as you wish it to appear on diploma)

First Name or Nickname for Badge

Last Name

Bank Name

Bank P.O. Box and Street Address

City

State

ZIP

Bank Phone Number

Attendee Cell Phone Number

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* 2. Additional information

Attendee Work Email *

Attendee Personal Email (in case attendee can't access email outside of office while at school as testing/evaluations are done by email)

Main Bank Name (if different)

Main Bank Address (if different)

In case of emergency, contact (Name & Phone Number) *

Roommate Request, if Applicable (Name and Bank)

Job Position/Title *

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* 3. Enrollment Fee - Upon acceptance into the School, registrants will be invoiced by email for the applicable enrollment fee approximately two weeks before the School. Nonmembers of their State Banking Association must pay an additional fee of $1025.

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* 4. Do you want your in class presentation handouts in electronic format only, or do you want printed materials? PLEASE NOTE: If you choose electronic, you must bring a tablet or laptop with your handouts loaded and ready to go (will be provided in advance of the school) in the classroom. Some materials may still be provided in paper format for class exercise purposes.

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* 5. Total Assets of Your Organization

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* 6. Total Years Financial Services Experience

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* 7. What is your primary compliance experience?

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* 8. Total Years Compliance Experience

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* 9. Educational Background:

Please specify college major if applicable:

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* 10. Enrollment Agreement: I have read the School brochure and agree to abide by assigned housing arrangements and all requirements for completion of this School. I consent to the release of grades and other performance measures to my employer.

Applicant Name

Nominating Officer Name

Nominating Officer Title

Nominating Officer Email Address