Certificate in Nonprofit Human Service Management Program

Application

Please attach the completed Supervisor’s Recommendation/Agency Commitment Form and return by August 3, 2012 or earlier. Applications are reviewed on a rolling basis. Space is limited.

Name

Job Title

Agency

Council Member (Yes / No)?_____

Work Address

Work Phone Cell Phone Fax

Select the program(s) you want to attend.
The Certificate in Nonprofit Human Service Management involves five blocks of classes from September – May. The Advanced Studies in Administration is an optional sixth block in May and June. The Advanced Studies Program is only available to those who have completed the prior five blocks of classes in the Certificate Program.

I would like to attend the:

__ Certificate in Nonprofit Human Service Management __and Advanced Studies in Administration & Finance

at:

___ Clark University, Worcester only___ Suffolk University, Boston only __ Either Worcester or Boston location

Brief job description

Briefly describe your previous work experience

Years of professional experience: ___ yrs. Years of supervisory/management positions: ___ yrs.

Education: (check if completed or fill in number of years attended if applicable and include your area of study)

__High school diploma/GED __Associates Degree in ______(area of study)

__Bachelor Degree in ______(area of study)__Masters Degree in ______(area of study)

Describe what you think will be your next job

Please attach a 500 word essay on why you would like to participate in this program, and specific ways this program will help you in your career.

Participation Contract

I understand that my enrollment in the Certificate in Nonprofit Human Service Management Program (CNHSM)requires my commitment to attend classes (at least 80%), pay for class materials as required (about $100 per session) to participate fully in the curriculum, and to participate in an evaluation of the program. I also understand that after attending the second class meeting my tuition is no longer refundable. In exchange for my agency’s supporting my participation by providing me with paid time-off to attend classes, I agree to continue working for my current employer for at least one year after graduation from the program.

Applicant signature______Date ______

Certificate in Nonprofit Human Services Management

Supervisor’s Recommendation/Agency Commitment Form

Supervisor’s NameTitle

OrganizationAddress

AddressCity______Zip

PhoneEmail

Applicant’s Name ______

Please complete the following andattach a signed recommendation letter.

I have supervised the applicant for ______years, and have known the applicant’s work for ______years.

S/He is in the top  5%  25%  50% of all the people whom I have supervised.

In five years, I expect the applicant to be able to assume a position as ______.

I recommend the applicant for participation in the Certificate in Nonprofit Human Service Management Program

Supervisor’s Signature______Date ______

Tuition Fees:MembersNon-Members

Certificate in Nonprofit Human Service Management Program$2,000$3,200
Certificate in Human Service Management with Advanced Studies$2,600$3, 800

in Administration and Finance

As the applicant’s Sponsoring Agency representative, I agree to pay a $50 nonrefundable Agency Application Fee (a onetime fee, regardless of the number of applicants) and agree to pay the tuition fee of ______. I understand that the tuition fee is not refundable after my employee attends the second class meeting. I realize that participants in the program must attend at least 80% of the classes to be eligible to graduate and agree to give enrolled employees paid time off in order to attend classes and participate in an evaluation of the certificate program, and to adjust their work requirements accordingly. I understand that all Certificate Program enrollees will commit themselves to continued employment with their sponsoring agency for at least one year following their graduation.

Authorized Sponsoring Agency Signature ______Date______

Return completed application, with payment made out to the

Human Service Providers Charitable Foundation, Inc., by August 3, 2012to:

Certificate Program Admissions Committee,

Provider’s Council, 250 Summer Street, Suite 237, Boston, MA02210

Questions? Contact Sara Morrison Neil at or 617.428.3637 x. 117