Senior Project Executive Certificate Program Application

Today's Date:

What factor had the most influence on your decision to apply to this program?

If "A previous participant of a Cheetah Learning program," please specify:

Name:

Program/Year:

If "Other," please specify:

Select three classes that will fit with your schedule for the Senior Project Executive Cohorts.  If your application is accepted, we will do our best to get you in one of the three cohorts you chose. You go through the in-person classes with the same group of people called a "cohort."  There are two in-person classes in Phase II of this certificate program.  The first course you meet the other people in your cohort, learn how to collaborate virtually, use the online courses, and learn how to facilitate project team development with people of widely varying project management competencies.  The second in-person class is a project executive leadership program where you learn and practice project executive leadership skills.  You and your cohort decide on where and when this second session will be held.  The second session has to be held within twelve months of your first class.  The collaboration and relationships developed in the in-person programs are carried into our online learning environment and improves your learning.  Cohort size is kept to 12 students to improve group interaction. (if you are not yet a PMP, you have to become a PMP before joining a cohort in Phase II of this program):

20040401 - April 1-2, 2004 - Seattle SPE Intro
20040501 - May 6-7, 2004 - Connecticut - SPE Intro

20040502 - May 20-21, 2004 - Vancouver, BC - SPE Intro
20040502 - June 10-11, 2004 - Seattle - SPE Intro
20040903 - September 27-28, 2004 - Chicago - SPE Intro
20041001 - October 7-8, 2004 - Connecticut - SPE Intro
20041002 - October 21-22, 2004 - Seattle - SPE Intro
20041101 - November 11-12, 2004 - Chicago - SPE Intro
20041102 - December 2-3 2004 - Connecticut - SPE Intro

General Information

First Name:

Middle Initial:

Last Name:

Prefix (Mr., Ms.):

Nickname for name badge:

Gender:

Male Female

Country of Citizenship:

Date of Birth (month/day/year):

BUSINESS ADDRESS

Title or Position:

Company Name:

Street:

(P.O. boxes accepted outside U.S.)

City:

State/Country:

Zip/Postal Code:

Business Telephone:

Fax:

E-mail:

Company Web Site:

HOME ADDRESS

Street:

City:

State/Country:

Zip/Postal Code:

Home Telephone:

Please select your current
industry (choose one only):

Specify Other:

Work Experience

Please list your positions in reverse chronological order, starting with your current one. If all are in the same company, please give the major promotional sequence.

Please estimate total number of years of professional Project Management experience:

Education

To assist us in matching the program agenda with the objectives of the participants, please check the box that most closely describes the amount of prior experience and familiarity you have with each of the following areas:

Please describe your role and the critical decisions in which you are involved in with your company:

What are your company's most important goals for the next five years and how will your attainment of the Senior Project Executive Certification help meet those goals?

Please describe the personal objectives that you hope to achieve through participation in this program, and how achievement of these personal objectives relates to the needs of your organization:

Do you have any concerns about participating in this program? If yes, please describe:

Please describe your Project Management leadership experience, your responsibilities, and relevant outside activities:

Family or other personal information (including recreational interests & hobbies):

Language Proficiency

Proficiency in written and spoken English is essential for participation in the Senior Project Executive Certification Program

Cancellation Policy

Payment is due within 30 days of the invoice date or upon receipt of the invoice if admission is within 30 days prior to the start of the Program. Cancellations or deferrals must be submitted in writing up to 30 days prior to the start of the program to receive a full refund. Due to program demand and the volume of preprogram preparation, cancellations or deferrals received within 30 days prior to the start of the program are subject to a fee of one-third of the program fee; within seven days are subject to two-thirds of the program fee. Cancellations or deferrals after the start of the program are subject to full payment. All subsequent cancellations or deferrals are subject to a cancellation fee.

Upon acceptance, payment is required prior to the program start date.

In accordance with Cheetah Learning policy, the Cheetah Learning does not discriminate against any person on the basis of race, color, sex, sexual orientation, religion, age, national or ethnic origin, political beliefs, veteran status, or disability in admission to, access to, treatment in, or employment in its programs and activities.