Application: Think Tank MBA 2014
October 31-November 12, 2014 - Fairfax, Va

1.

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* 1. Please provide the following information:

Name: *

Organization: *

Address 1: *

City/Town:

State/Province: *

ZIP/Postal Code:

Country: *

Email Address: *

Year Organization was Founded: *

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* 2. Position within organization?

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* 3. Organization Mission & Vision

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* 4. Please provide the amount of organization staff that fit the following:

Full Time

Part Time

Volunteer

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* 5. Select the option that best describes your organization

Home office

Rented office space

Owned office space

Other (please specify)

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* 6. Annual Budget of your institute in USD

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* 7. Do you have donors in the following fields? If so, how many?

	Number
Individual	Individual Number menu
Foundation	Foundation Number menu
Corporate	Corporate Number menu
Government	Government Number menu

Other (please specify)

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* 8. Briefly list the major programs and activities of your organization

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* 9. Please provide at least one example of impact achieved by your organization.

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* 10. Please provide 3 strengths and 3 weaknesses of your organization

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* 11. In 5 years, How do you see your organization making an impact in your country or region? What steps does your institute plan to take in order to accomplish that vision?

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* 12. What are your long term professional goals? How long do you plan to stay with your organization?

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* 13. Please list any Atlas programs or events you have participated in, if possible, include month/year.

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* 14. Please discuss how your current position adds value to your organization's mission.

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* 15. What skills and experience will you bring to the Think Tank MBA program?

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* 16. As part of the Think Tank MBA you will create a detailed strategic plan. How will this benefit you and your organization?

Thank you for completing this application to participate in the Think Tank MBA. To complete your application, please send a photo, resume and bio to Autumn.lansford@atlasnetwork.org. The deadline for applications is June 30, 2014 and decisions will be made by early July.