Discount Application

YOUR NAME*

YOUR EMAIL*

HOW MANY EMPLOYEES WORK IN YOUR BUSINESS
1 - 2021 - 5051 - 100100- 300300 - 500500+

WHAT STATE IS YOUR BUSINESS IN

DO YOU HAVE A FULLY DOCUMENTED COMPLIANT DIVERSITY & INCLUSION PLAN
YesNoDon't know

IS YOUR BUSINESS A MINORITY OR WOMAN OWNED BUSINESS
YESNO

WHAT IS THE APPROXIMATE RATIO OF WHITES/CAUCASIANS Vs MINORITIES IN YOUR ORGANIZATION
90%+ White70% White vs 30% Minority50 / 50 White / Minority30% White v 70% MinorityLess than 10% White

CAN YOUR ORGANIZATION AFFORD TO INVEST $499 (1 time/lifetime fee) FOR YOUR REGISTRATION FEE IF THE SCHOLARSHIP COVERS SOME/ALL OF THE REMAINING $11,709 FOR THE ENROLLMENT FEE
YESNO

WHAT IS YOUR TITLE / AREA OF RESPONSIBILITY WITH YOUR COMPANY?

ARE YOU 1 OF THE PRIMARY DECISION MAKERS IN YOUR BUSINESS FOR DIVERSITY & INCLUSION PROGRAMS AT YOUR COMPANY
YESNO

APPROXIMATELY HOW MANY C LEVEL EXECS, MANAGERS, SUPERVISORS DOES YOUR COMPANY EMPLOY

ARE YOU COMMITTED TO IMPROVING DIVERSTY & INCLUSION FOR YOUR ORGANIZATION WITHOUT DISPLACING YOUR CURRENT NON-MINORITY STAFF?
YESNO

WHAT WERE YOUR GROSS REVENUES OVER THE LAST 12 MONTHS
Less than $500,000$500,000 to $1 million$ 1 million to $5 million$5 million to $10 million$10 million +$ 100 Million plus does not qualify

PHONE #

BEST DATE & TIME TO CALL YOU (include time zone)