1. Preferred Date To Attend:

   July 14-25, 2008 August 11-22, 2008 Either
2. Name (first, last) for certificate:
3. Name (first, last) for name tag:
4. Title:
5. Agency/Organization:
6. Department/Division:
7. Mailing Address:
8. City:
9. State:
10. Zip:
11. Phone: (enter as: XXX-XXX-XXXX)
12. Fax: (enter as: XXX-XXX-XXXX) (NR)
13. E-mail:

14. Are you an Elected or Appointed official?

    Yes No
15. If yes, year first elected/appointed:

16. Public sector employees choose one: (NR)

    Federal State County City Port
17. Number of People You Directly Supervise:
18. Number of People Responsible to You Overall:

19. Are you an Evans School of Public Affairs alumnus?

    Yes No

20. How did you hear about the Cascade Executive Programs (check all that apply):

    Co-worker Nominator Supervisor Brochure E-news Website Other (please explain):
21. Please copy and paste a resume or curriculum vitae (total length not to exceed 6000 characters):

22. Will you need Disabilty Accommodations?
    A member of our staff will contact you at least three weeks prior to the proram to discuss special needs.

    Yes No

23. I understand that I am responsible for attending all sessions, completing all class preparations, and that certification of completion is based on attendance at all sessions and full participation in study groups and other activities in the program. If self-sponsored, I have read and agree to the terms of the payment policy and cancellation policy.

    Yes No

1. Is the participant self-nominated?

   Yes No

1. I nominate the above individual for admission to the 2008 Executive Management Program and agree to make her/him available for full participation in the program. I understand that the individual is expected to attend all sessions and prepare the required coursework. I have read and agree to the terms of the payment and cancellation policy.

   Yes No
2. Nominating Official Name:
3. Title:
4. Mailing Address:
5. City:
6. State:
7. Zip:
8. Email:

Tax ID Number 91-6001537.
All invoices should be sent to:

1. Is the participant self-sponsored?

   Yes No

1. Name:
2. Agency:
3. Department:
4. Mailing Address:
5. City:
6. State:
7. Zip:
8. Phone: (enter as: XXX-XXX-XXXX)
9. Fax: (enter as: XXX-XXX-XXXX)
10. E-mail: