Application

First and Last Name *

Company Name

Work Phone Number *

Work Email *

Personal Phone Number *

Personal Email *

Address (Home or Work) *

What are your reasons for applying for enrollment in the Bear paw Peacemaking Certificate Program? *

Once you complete the Certificate Program, how and where do you want to apply the training? *

Which phone number and email address would you like us to use to correspond with you regarding your application? *

If employed, is your employer supportive of giving you the necessary time off to attend all the training days? *

If your employer will be paying for the training, please supply the name of the contact person for invoicing and payment.

Bear Paw Peacemaking Certificate Program Application