2021 Georgia Banking School Application Question Title * 1. Please enroll me as a: First Year Student (Class of 2023) Second Year Student (Class of 2022) Third Year Student (Class of 2021) OK Question Title * 2. Applicant Information First Name Last Name Company/Bank Title Area of the Bank (i.e. Commercial Lending, Marketing, Retail etc.) Business Address Business Address 2 City State ZIP Code Email Address Office Phone Number Cell Phone Number OK Question Title * 3. Name (as you want it to appear on your name badge): OK Question Title * 4. Name (as you want it to appear on your diploma): OK Question Title * 5. Association status: Note: Bankers from outside of Georgia are cordially invited to enroll. If your bank is a member of your state banking association, we will extend the member tuition price to you. Non-member student tuition is $2,965. GBA Member/Associate Member Non-Member Institution OK Question Title * 6. Total years in banking: Less than 5 years 5-10 years 11+ years OK Question Title * 7. Total assets of bank: $1 - $150 M $151 M - $1.5 B Over $1.5 B OK Question Title * 8. What is the highest degree or level of school you have completed? If currently enrolled, select the highest degree received. High school/GED Some college credit, no degree Trade/technical/vocational training Associate degree Bachelor’s degree Master’s degree Professional degree Doctorate degree OK Question Title * 9. What are your primary areas of responsibility? (Select all that apply) Accounting Auditing Branch Banking Commercial Lending Compliance Consumer Lending Credit Analysis Information Technology Marketing Operations Personnel/HR Security Other (please specify) OK Question Title * 10. Indicate housing preference and requests below. Two students will be assigned per room with two double beds. You may note a roommate request or GBA will assign a roommate to you. Please note the UGA Conference Center Hotel is a non-smoking hotel. Assign a roommate to me. Reserve a single room for me for an additional $385. I don't need a room. I would like to share a room with: OK Question Title * 11. Special hotel requests: OK Question Title * 12. Gender (for room assignment purposes): Female Male OK Question Title * 13. Check all dietary restrictions or allergies. Kosher meals are not available. Vegetarian Nuts Dairy Pork Shellfish Gluten/Wheat Other (please specify) OK Question Title * 14. Nominating Officer Information First Name Last Name Title Business Phone Email OK Question Title * 15. Upload a current photo for the Georgia Banking School student directory. DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only. Choose File Choose File No file chosen Remove File Upload a current photo for the Georgia Banking School student directory. OK Question Title * 16. Acknowledgment of School Commitment: I understand that, to qualify for graduation, I will be expected to attend all scheduled classes, prepare all assigned work, participate in classroom sessions, and satisfactorily complete all assigned home study problems. I hereby authorize the release of my grade to the GBA and my bank's CEO and/or nominating officer. This information is to be treated as part of my confidential personnel file. I agree. OK DONE