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.
Name*
First Last
Employer*
Title
Email Address*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Are you based outside of Nashville?
- Yes
- No
Will you need overnight accommodations during the program?
- Yes
- No
Office Phone Number
Extension (if applicable)
Cell Phone Number
Home or Alternate Phone Number
Extension (if applicable)
Emergency Contact Number
Extension (if applicable)
Business Sector*
Please confirm your business function area.
Please list your highest degree of education
Please define diversity and inclusion
Please list previous experience(s) relative to diversity training.
What do you hope to gain from a diversity training certificate program?
Please list two references
Name of Professional Reference
First Last
Email Address
Phone
Extension (if applicable)
Permission to contact?
- Yes
- No
Name of Community Engagement Reference
First Last
Email Address
Phone
Extension (if applicable)
Permission to contact?
- Yes
- No
Field Study / Bus Tour
Photo and Video Permission*
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.
Assumption of Risk, Waiver of Liability and Indemnification Agreement*
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.
Signature

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Name
This field is for validation purposes and should be left unchanged.

NOW Diversity

The National Organization for Workforce (NOW) Diversity is a private, public and non-profit collaborative created to provide insight and leadership training to advance workforce diversity initiatives.

Purpose Statement:
The National Organization for Workforce (NOW) Diversity is a 501(c)(3) nonprofit organization committed to the representation, engagement, and understanding of the workforce communities served. The strategic focus is on employment inclusion and engagement. We develop and execute resources for the workforce, education and nonprofit community.

Mission Statement:
Driving Innovation, Opportunity and Best Practice in the workplace by advancing diversity awareness.

Home » Diversity Certificate » Workforce Diversity Certificate Pre-Registration Application

Workforce Diversity Certificate Pre-Registration Application

Pre-Registration Application

Please list two references

Field Study / Bus Tour

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