Jim Moran Institute for Global Entrepreneurship


Nonprofit Executive Program Registration Form
NPEP is for CEOs, Presidents and Executive Directors. The organization needs to be established for at least three years, preferably more than five years, and have three or more employees and/or volunteers (preferably employees). Candidates must be actively involved in running the organization and be the key decision maker. All information is kept confidential between the Registrant and the Jim Moran Institute.
General Information
Jacksonville NPEP Class *
First Name *
Middle Name
Last Name *
Title or Position *
Birth Date	// (mm/dd/yyyy)
Race/Ethnicity	American Indian or Alaska Native Asian Black or African American Hispanic or Latino Middle Eastern or North African Native Hawaiian or Other Pacific Islander White
Highest Education Level *
Gender
Personal Contact Information
Email Address *
Phone *
Phone Type *
Phone2
Phone Type 2
Home Address 1 *
Home Address 2
Home City *
Home State *
Home Zip Code *
Organization Information
Organization Name *
Employer Identification Number (EIN) *
Address 1 *
Address 2
City *
State *
Zip Code *
Type of Organization *
Describe your Organization *
Year Organization was Founded (yyyy) *
Nonprofit Legal Entity *
If "Other", please specify
Are you the Founder? *
Is this a Home-based Organization? *
Please provide your best estimates if the information is not yet available.
Current Full-time Employees (#) *
Current Part-time Employees (#) *
Current Contract Employees (#) *
Current Volunteers (#) *
Prior Year Gross Revenue ($) *
Prior Year Expenses ($) *
Annual Personal Compensation *
Work Experience
Please list your positions in reverse chronological order, starting with your most recent positions.
Name of Company / Organization *
Title or Position *
From-to (Year) *
_
Name of Company / Organization
Title or Position
From-to (Year)
Social Media
Please provide links to your website and social media pages
Website
https://www.facebook.com/
https://www.instagram.com/
https://www.linkedin.com/company
https://www.linkedin.com/in/
https://x.com/
Narrative
Please describe your role and the critical decisions in which you are involved.
Role and Decisions *
What are your organization's most important goals for the next five years?
Goals *
Please describe the personal objectives you hope to achieve through participation in the NPEP and how they relate to the needs of your organization.
Personal Objectives *
Do you have any concerns about participation in the Nonprofit Executive Program?
Concerns *
How did you hear about the program? *
To assist us in matching the program agenda with the objectives of the participants, please check the box that most closely describes the amount of prior experience and familiarity you have with each of the following areas:
Strategic Planning *
Lean Business Model *
Marketing *
Technology *
Accounting *
Finance/Financial Analysis *
Human Resources *
Separate from this program, the Jim Moran Institute offers exclusive programs for FSU alumni and military Veterans. For informational purposes only:
Have you attended Florida State University?	Yes
Are you a Veteran or military spouse?	Yes
By submitting this registration, I acknowledge that attendance and participation in all sessions is mandatory. In addition, I consent to allow the Jim Moran Institute to use all photographs and videos taken at this event in future marketing efforts.
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Nonprofit Executive Program Registration Form

General Information

Personal Contact Information

Organization Information

Work Experience

Social Media

Narrative