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Emergency Management for Government and the Public Sector
Application for Admittance to the Certificate Program

 

Please complete the form below and click the Submit button. You will be notified in writing regarding your acceptance into the program.

 

To register by mail, click here to download the registration form (pdf).

 

If you have a question, please call us at (334) 844-4781.

 

PERSONAL INFORMATION ...............................................

Salutation:	Mr. Ms. Mrs.
Name:
Position / Title:	Select... Manager Teacher Librarian Officer Accountant Consultant Customer service representative Program Manager Engineer Software Engineer Project Manager Cashiers Doctor Secretary Office Manager Nurse Team Leader Analyst Designer Programmer Marketing Executive Dentist Assistant Recruiter Office clerk Auditor Researcher Trainer Scientist Editor Director Driver Lawyer Sales Executive Pharmacist Supervisor Technician Programmer Marketing Executive Receptionist Trader Supervisor Serviceman office Manager Administrator Store Manager Social Worker Artist Student Retiree Unemployed Veteran
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Years employed in current position:
Years employed in government/public sector:
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ACADEMIC INFORMATION ..............................................

Degree(s) earned & Major(s):

ADDITIONAL INFORMATION ............................................

Additional experience for consideration:

• Note: Please make sure that the information provided here is accurate.