Registration Form

Graduate School of Business
Certificate in Executive Leadership

Personal Information

Legal First Name

Last Name

Date of Birth

Social Security Number (required for IRS)

Email Address

Preferred Phone Number

Mailing Address

Country

Street

City

Region

Postal Code

Occupation and Title

Organization

Registrant Type:

Current WU Student

Whitworth MBA Alum

Community Member

Course Equipment Fee

A $200 course equipment fee is due at the time of registration.

Amount Due
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Amount Due

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Statement of Student Financial Responsibility

Submission of registration form obligates the student for payment of applicable tuition and fees as well as any subsequent collection expenses and fees calculated on unpaid balances and implies acceptance of the financial policies.

CONTACT:
Graduate School of Business
300 W. Hawthorne Road | Spokane, WA 99251
Ph: 509.777.4606 | svoorhees@whitworth.edu

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