VISION HOUSE

Application for Training

Fill out the following information, print, sign and fax back to Vision-House at:

425.430.9590

Name:

Current Position:

Today’s Date :

Address:

Agency Name:

Agency Address:

Agency’s Web Address:

Telephone (Personal):

Telephone (Business)

Telephone (Mobile):

E-mail Address:

Level of Experience in the Field

Beginning Stages|Active for 1-5 Years
Active for 6-10 Years
Active 11+ Years

Number of Staff Members

0
1-5
6-10
11-20
21+

How did you hear about this training?

General Expectations/Specific Needs/Greatest Area of Interest?

Please mark the sessions you would like to attend?

Day 1 – Basics of Starting a Non-Profit Organization
Day 2 – Developing a Successful Program

EDUCATION

Highest grade completed?    
     

  Where?

Special Training Received?

EMPLOYMENT

Please list previous or current employment specific to your area of interest or training.

Employer:

Type of Work:

What are your professional goals for the next 12 months?

Applicant Signature:

Date: