Envoy Application and Commitment Form

Envoy Application and Commitment Form
Thank you for your interest in becoming a WBEC-East Envoy! If you have not already done so, please refer to the Envoy Program Guidelines
Name *

First Name Last Name
Title
Your role at your company
Email *
example@example.com
Company Name *
Company Street Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Years in Business
Years Certified
Number of Employees
Your best estimate is fine
% Ownership
Are you a new Envoy applicant or a returning Envoy? *

New Returning

New Envoy Application
What is your primary role within your company?
Why did you choose to become a WBENC-certified Women Business Enterprise?
Why do you want to participate in the Envoy program?
Please describe previous experience relevant to the role of the Envoy as an educator, facilitator, and communicator, including any public speaking experience. (Refer to guidelines with any questions)
Are you aware of the Dorothy Brothers Scholarship? (Knowledge of this program is not required to be considered for the Envoy program)

Yes, I am aware but have not been a recipient of this scholarship Yes, I am aware and have been a recipient of this scholarship No, I am not aware of this scholarship
Are you aware of the WBENC Tuck Program? (Knowledge of this program is not required to be considered for the Envoy program)

Yes, I am aware but have not participated in the Tuck program Yes, I am aware and have participated in the Tuck program No, I am not aware of this program