Furman University

Application Form

Please provide the following information which will be considered in your application to the Program. The Program will be limited to (20) students per session. The acceptance of applications will be made by the Director of the Program. You will be contacted after submission and review of the application.

Date:
Name:
Organization:
Title:
Email:
Phone:
Fax:
Address:
City:
State:
Zip:
Do you have a preference in terms of Program Session: (check all that apply) Fall 2012

Please provide a brief description of your organization: (products/ services, size, number of locations, number of employees)

Does your organization have a Vision or Mission Statement, if so, please tell us what it is: (products/ services, size, number of locations, number of employees)

What area of the organization do you work in:

What are your responsibilities?

What is your interest in this program: (check all that apply) As a practitioner, you are responsible for implementing sustainability initiatives in your organization. Exploratory, your organization is in the educational process. Other

If "Other", please specify:

If your organization has made a commitment to sustainability initiatives, what are your responsibilities in this area now or into the future?

Please briefly describe what you think the definition of green or sustainability is in your organization: (If you do not have one, that is fine, just let us know.)

Does your organization currently have any stated sustainable or green goals? (If yes, please list them.)

Does your organization have any green programs in place currently?

Please list or tell us what your organization's expectations are in terms of this Program:

Please tell us what your personal expectations are in terms of this Program:

Will you have the time between classes to read content provided including: books, articles, videos?   Choose one... Yes No

[Optional] Please provide us a brief background on you: (education, skill mix, personal likes/dislikes, family, etc.)

Please provide emergency contact information: (Supervisor's name and contact info, In Case of Emergency info)

Is there any additional information we need to know about you or your organization?

Do you have a laptop computer?	Choose one... Yes No
Do you have an Amazon Kindle?	Choose one... Yes No
Do you have an iPhone?	Choose one... Yes No
Do you have a PDA?	Choose one... Yes No
Are you allergic to any particular food?	Choose one... Yes No
If "Yes", please specify:
Are you a vegetarian?	Choose one... Yes No