Spring 2019 Risk Leadership Certificate Program Application

About You

Please answer a few simple questions and provide contact information.

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* 1. Contact Information

Name

Title

Organization Name

Address

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Preferred Phone Number

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* 2. Selection as a candidate for the Risk Leadership Certificate Program requires participation in three in-person weekend sessions, and completion of assignments. Please indicate if you are able to make a commitment to these minimum requirements.

Session 1: March 8-9 at NRMC headquarters in Leesburg, VA
Session 2: March 29-30 at NRMC headquarters in Leesburg, VA
Session 3: April 26-27 at NRMC headquarters in Leesburg, VA

Yes.

No.

Comments or Questions

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* 3. RLCP tuition is $4,500. This amount includes accommodations in Leesburg, but not RT travel to and from Leesburg. Tuition is $3,500 for participants who do not need accommodations in Leesburg. One partial scholarship is available for Spring 2019. Please choose the answer that best matches your circumstances with regard to tuition.

I am prepared to cover the full cost ($4,500) of attending RLCP this Spring 2019.

I am able to pay the cost of tuition ($3,500), but will not need accommodations in Leesburg.

I would require a partial scholarship of $1,500 to participate in RLCP.

Other (please specify)

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* 4. Tell us Why - Please tell us why you are interested in participating in the Risk Leadership Certificate Program.

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* 5. Describe your experience in risk management--generally and specifically. For example, have you held or do you currently hold a position with responsibility for risk management? If so, what does that responsibility entail?

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* 6. Please describe two or three specific learning or professional goals that you have for this program.

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* 7. NRMC will select 6-8 individuals to participate in the Spring 2019 RLCP, and each participant is expected to be an active participant and contributor. What special knowledge, experience or perspective do you bring to the program that you're eager to share with others in your cohort?