This is the address that we will use for our distribution lists this coming year.
Please indicate whether this is a home/work/cell number and under what circumstances it should be used.
If something happens to you, who should we contact and how?
Are you on LinkedIn? Please share your profile URL (copy and paste it from the website).
Please provide a biography and summary of your qualifications.
Please write this in the third person!
We compile this information and distribute it to the participants, the program committee, and will post it on our website to highlight the qualifications of our team. It is also used occasionally in submitting our program for grant applications or to support employers in applying for funds to cover tuition. Maximum characters: 3000 (about 400 words).
We use this information to customize/inform catering orders for the retreat, learning days, and graduation. Please enter "none" if you have none.
Please indicate which program delivery functions you want to be involved with for 2017-18. I'll be making distribution lists that allow us to direct certain communications to people with these interests when appropriate.
Please choose a photo of you that we can include in the CPC "Who's Who" Handout for participants. A head-and-shoulders shot is the best idea.
Accepted file types: jpg, gif, png.
- Thank you very much for helping me keep our records up to date in this efficient way.
This field is for validation purposes and should be left unchanged.