Fall 2017 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 held at NRMC headquarters in Leesburg, VA (October 6-7, October 27-28, and November 17-18), completion of assignments, and payment of the tuition for the program ($4,500). Please indicate if you are able to make a commitment to these minimum requirements.

Yes.

No.

Comments or Questions

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

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

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* 6. NRMC will select 8 individuals to participate in the Fall 2017 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?

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