KAI Accreditation Course Application

Questions marked with a * are required

Select your first choice attendance date:

December 10-13, 2024: onsite at Roanoke, Virginia, with prior online coursework, Hybrid

April 8 - June 18: Online, Module Course Design. Scheduled meeting dates on April 8 -10, and June 17-18

Select your second choice attendance date:

December 10-13, 2024: onsite at Roanoke, Virginia, with prior online coursework, Hybrid

April 8 - June 18: Online, Module Course Design. Scheduled meeting dates on April 8 -10, and June 17-18

I understand information shared in this online application will be shared with KAI Foundation, the Center for Cooperative Problem Solving at Virginia Tech, and eventually fellow Accreditation Course participants, unless otherwise stated:

I understand

First Name:

Last Name:

Preferred Title (e.g Mr., Mrs., Dr., Prof. etc):

Please list your name as you wish it be written on your certificate:

Please provide your earned university degree(s) with subject type, year, university name, and location:

Please list your Occupation/Field of work:

Please provide your employer/company name:

What is your job title?

Work phone:

Mobile/Cell phone (For KAI and internal use only and not shared with Accreditation Course participants):

Work Email Address:

Home email address: (For KAI and internal use only and not shared with Accreditation Course participants):

Work postal address:

Please provide the mailing address you would like to use for your KAI Resource Box, if different than your work postal address:

Please indicate your knowledge or experience with KAI:

Please indicate your knowledge or experience with other psychometric measures:

Please share your background, field of work, and interests that tell us a little bit more of your experience (for example, previous military experience and specialize in engineering, and currently responsible for leadership development, and have a private consultancy as well):

Please list any other relevant information that may help us prepare for your learning needs in the Accreditation Course:

Please list your website:

Please list your LinkedIn Profile link:

Please list your Twitter Profile link:

Please provide the email you will use to log into the Zoom meeting:

I understand this is an application for the Accreditation Course, and upon acceptance, will be contacted prior to the course date to complete my enrollment, and provide payment:

I understand