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Workforce Diversity Certificate Pre-Registration Application

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  • Pre-Registration Application

    Fill out the form below to submit your application. Please note that submission of this application / pre-registration does not confirm acceptance. Notices of acceptances will be sent by email with payment information and other details. Full payment must be received for enrollment confirmation.

    Questions? Please email workforcediversitycertificate@gmail.com.
  • Please list two references

  • Field Study / Bus Tour

  • I agree that my image my used by the National Organization for Workforce Diversity during activities associated with the Workforce Diversity Certificate program or associated events. My image may be used for any purpose, including promotional purposes.
  • I hereby waive, release, discharge, indemnify and hold harmless the National Organization for Workforce Diversity and its Board of Trustees, officers, employees, agents and representatives (herein collectively referred to as the “NowDiversity.org”) from any and all liability arising out of, or in connection with participation in the above described activity(ies), including travel, and INCLUDING LIABILITY ARISING FROM THE NowDiversity.org’s perceived negligence.
  • Hold the left click button on your mouse to write your signature in this box.
  • This field is for validation purposes and should be left unchanged.