Columbus State UniversityExecutive CollegeA Program of Columbus State University
Continuing and Justice Administration Outreach
4225 University Avenue - Columbus GA 31907Phone (706) 568-2190 Fax (706) 568-2137
Dr. Archie Rainey Ms. Laurie SkibbeDirector Associate [email protected] www.ColumbusState.edu/command [email protected]
Appointment Application
__________________________________________________________________________________________________Last Name First Name Middle Name SS Number
__________________________________________________________________________________________________Title/Position
__________________________________________________________________________________________________Organization/Agency
__________________________________________________________________________________________________Street Address City State Zip Code
__________________________________________________________________________________________________Phone Number Fax Number
__________________________________________________________________________________________________E-Mail
Years of service with current employer ________________________
Years in supervisory positions ________________________________
Education Level:
______60 Semester Hours\90 Quarter Hours
______Bachelors Degree ______Graduate Degree
Training:
______________________________________________________________________________________________
______________________________________________________________________________________________In addition to the Appointment Application, you are required to submit a resume a completed nomination form.
__________________________________________________________________________________________________Signature of Applicant Date
NOMINATIONTO ATTEND THE COLUMBUS STATE UNIVERSITY EXECUTIVE COLLEGE
The Executive College is an advanced program of study focusing on developing leadership and management skills.The program will require at least 280 hours of classroom study divided into seven (7) modules extending over aperiod of approximately two (2) years with significant out-of-class assignments. To include an independent researchproject.
Nominee:
__________________________________________________________________________________________________Last Name First Name Middle Name SS number
__________________________________________________________________________________________________Title/Position Organization/Agency
__________________________________________________________________________________________________Agency Address Phone Number
Nominated By:
__________________________________________________________________________________________________Last Name First Name Middle Name
__________________________________________________________________________________________________Title Position Organization/Agency
I hereby nominate ______________________________________________________________________________________Name of Nominee
of the __________________________________________________________________________________________________Name of Organization or Agency
to attend the Columbus State University Executive College.
__________________________________________________________________________________________________Signature of Nominator Date
MAIL TO: Archie Rainey, Ph.D.Justice Administration OutreachColumbus State University4225 University AvenueColumbus, GA 31907-5645Phone: (706) 568-2190Fax: (706) 568-2137E-Mail: [email protected] Site: www.ColumbusState.edu/command
