Positive Leadership Certificate Program
Positive Leadership Certificate Program *This information is required to maintain a permanent record of your non-credit activity in Mason’s student information system. If this information is not provided at the time of your registration the permanent record cannot be retroactively created. (Please print your Full Legal Name as it appears on your state issued ID card or passport) * Mr. Ms. First
Please Check One
Middle
Last G Number (Mason ID #)
* Previous Name (If used at Mason)
First
Middle
Last * Date of Birth
Employer
Job Title
Work Address
* Home Address
City / State / Zip
* City / State / Zip
* Preferred E-mail
* Preferred Mailing Address
* Phone
Work
Home
Home
Work
Cell
How did you hear about this program? Yes
Would you like to receive our monthly e-newsletter?
No
All course modules meet from 8:30 am – 12:30 pm in Research Hall on the Fairfax Campus of George Mason University
LCCS 0300 F04 Positive Leadership Certificate Program
$ 1,995.00
Spring 2017 Cohort Schedule Positive Leadership – April 4 Mindful Leadership – April 18 Coaching Toward the Positive – May 2 Purposeful Leadership – May 16 Check discount box if appropriate: (only one discount may be applied)
Total Tuition - Discount Payment Total
10% Discount for George Mason University Alumni (Please provide G Number above) 10% Discount for three or more from your company (please register at the same time) 10% Education Alliance Organization
$ $ $
0.00
Company Name
Refund Policy: We recognize you may occasionally need to cancel your registration. You can substitute another individual in your place prior to your start. If you wish to receive a refund we must receive your written request for cancellation no less than seven business days prior to the course start date. If you request a refund, a $125.00 processing fee is deducted. We are sorry that we cannot provide a refund if we receive your written cancellation in six or fewer business days before the start of the course. If you have requested a refund it may take several weeks to process. Refunds for check payments may take up to six weeks since refunds are cut through the Commonwealth of Virginia. Payments will be refunded to the person/company that issued the original check to George Mason University. Refunds for credit card payments will be made only to the credit card used for the original payment. Processing time will vary based on your financial institution. Attendance Policy: To receive a certificate, a 75% attendance record must be achieved. Certificates of completion may take up to two weeks or longer to process once your program has concluded.
Mail to: George Mason University, Learning Solutions; 3351 Fairfax Dr., Arlington, VA 22201; MS 2G2 OR Fax to: 703-993-2121
Method of Payment – Space confirmed upon receipt of registration fee or purchase order. Note: If anticipated payment is not received by your company/sponsor, you are personally liable for all course fees. Please initial here to indicate you have read this statement:
VISA Cardholder Name (Please Print): Cardholder Billing Address (Required): Credit Card Number:
MasterCard
Check
P.O.
SF182
Cardholder Signature (Required): Cardholder Phone: Expiration Date:
DD1556
Please Check One
Middle
Last G Number (Mason ID #)
* Previous Name (If used at Mason)
First
Middle
Last * Date of Birth
Employer
Job Title
Work Address
* Home Address
City / State / Zip
* City / State / Zip
* Preferred E-mail
* Preferred Mailing Address
* Phone
Work
Home
Home
Work
Cell
How did you hear about this program? Yes
Would you like to receive our monthly e-newsletter?
No
All course modules meet from 8:30 am – 12:30 pm in Research Hall on the Fairfax Campus of George Mason University
LCCS 0300 F04 Positive Leadership Certificate Program
$ 1,995.00
Spring 2017 Cohort Schedule Positive Leadership – April 4 Mindful Leadership – April 18 Coaching Toward the Positive – May 2 Purposeful Leadership – May 16 Check discount box if appropriate: (only one discount may be applied)
Total Tuition - Discount Payment Total
10% Discount for George Mason University Alumni (Please provide G Number above) 10% Discount for three or more from your company (please register at the same time) 10% Education Alliance Organization
$ $ $
0.00
Company Name
Refund Policy: We recognize you may occasionally need to cancel your registration. You can substitute another individual in your place prior to your start. If you wish to receive a refund we must receive your written request for cancellation no less than seven business days prior to the course start date. If you request a refund, a $125.00 processing fee is deducted. We are sorry that we cannot provide a refund if we receive your written cancellation in six or fewer business days before the start of the course. If you have requested a refund it may take several weeks to process. Refunds for check payments may take up to six weeks since refunds are cut through the Commonwealth of Virginia. Payments will be refunded to the person/company that issued the original check to George Mason University. Refunds for credit card payments will be made only to the credit card used for the original payment. Processing time will vary based on your financial institution. Attendance Policy: To receive a certificate, a 75% attendance record must be achieved. Certificates of completion may take up to two weeks or longer to process once your program has concluded.
Mail to: George Mason University, Learning Solutions; 3351 Fairfax Dr., Arlington, VA 22201; MS 2G2 OR Fax to: 703-993-2121
Method of Payment – Space confirmed upon receipt of registration fee or purchase order. Note: If anticipated payment is not received by your company/sponsor, you are personally liable for all course fees. Please initial here to indicate you have read this statement:
VISA Cardholder Name (Please Print): Cardholder Billing Address (Required): Credit Card Number:
MasterCard
Check
P.O.
SF182
Cardholder Signature (Required): Cardholder Phone: Expiration Date:
DD1556
