Name:      Birth Date:
Business Name:       Title: 
Industry:      Years in Business:   
Business Phone Number: 
Address:
City, State, and Zip:     Country:
Website Address:      Email Address: 
Business Reference Name and Phone Number or Email:

Survey Information: This information will be come the property of Brigette's Technology Consulting and Research Firm (hereby known as, "the Firm") and may be used for research or shared with external entities.

Age:           Gender:  Male     Female     Transgender

Race:  African American  Caucasian American  Hispanic American  Other:

Highest Degree Earned: None  Some College  Associate  Bachelor  Master  Doctorate  Post Doctorate

For Applicant Who Are Not Current Learners:
Why are you not currently enrolled at an accredited university, and what are you interested in studying?

All Applicants: How do you believe this Designation will improve your future endeavors:
How do you believe this Designation will improve your future endeavors?

Certification Information (select one):

  Certified Intelligent Entrepreneur (CIE)© Designation Examination

  Certified Associate Entrepreneur (CAE)© Designation Examination

I. Certified Intelligent Entrepreneur (CIE)© Certification Exam

a. Criteria for Initial Examination:

• Complete an online questionnaire: http://www.brigettes.com/NewRealityCorporationConcept/SmallBusinessInfo.htm
• Possess a current business license (submit a copy)
• Been in business 8 or more years
• Acquired a minimum of 30 Professional Development Credits (PDCs), which include contract hours, from an external source dated from 2011 to present Attended the following type seminars/workshops: marketing, media/journalism, technology, healthcare administration, higher education administration, sustainable foods, maritime, project management, procurement, financial audit, and business regulations (submit proof of attendance and credits)
• Participated in a minimum of 2 projects for entrepreneurs constructed by the Firm or an external source:
  and

b. Cost:
       $1,500.00  3-year designation

c. Recertification Cost:

         $350.00  Extended 3-year designation

II. Certified Associate Entrepreneur (CAE)© Certification Exam

a. Criteria:

• Complete an online questionnaire: http://www.brigettes.com/NewRealityCorporationConcept/SmallBusinessInfo.htm
• Possess a current business license (submit a copy)
• Been in business 2 or more years
• Acquired a minimum of 20 Professional Development Credits (PDCs), which include contract hours, from an external source dated from 2011 to present: Attended the following type seminars/workshops: marketing, media/journalism, technology, healthcare administration, sustainable foods, higher education administration, maritime, project management, procurement, financial audit, and business regulations (submit proof of attendance and credits)
• Participated in a minimum of 1 project for entrepreneurs constructed by the Firm or an external source:

b. Cost:
         $1,000.00  3-year designation

c. Recertification Cost:

         $350.00  Extended 3-year designation

III. Practice Study Materials

         Information that may assist with preparing for the exam will be forwarded via email once the application is processed.

IV. Test

Three (3) hour examination must be given by an administrator (proctor), who must hold the designation: Doctor (i.e., Ph.D., DM, Ed.D., MD, ND, and so forth), at the cost of the applicant if any. The administrator, who is selected by candidate, however, cannot be a known relative. The examination, which is based on a 100-point scale, will be mailed to the administrator who is recommended to be located near the applicant's location.

Passing constitutes getting 80% of the answers accurate. Results will be delivered up to 3 weeks from date the completed exam is received at the Firm. If failed, test can be retook after 1 year from the date original score is assigned by the Firm's graders. If failed a second time, the test cannot be ever took again by the applicant.

V. Recertification (after 3-year period)

CIEs must earn 100 PDCs, and CAEs must earn 70 PDCs, which include contract hours, by attending any business-related seminars/workshops, such as marketing, media/journalism, technology, healthcare administration, sustainable foods, higher education administration, maritime, project management, procurement, financial audit, and business regulations. Ten (10) PDCs will be granted for every business related seminars attended. College courses will count for 10 PDCs. Include copy of certificates and/or highlighted transcripts.

VI. Acknowledgement

These examinations and designations were design by the Firm to provide credibility to business owners who desire to be recognized in the industry as a potential partner for outsourced initiatives.

VII. Payment

Payment Type Only:  Money Order Cashier/Official Check Corporate Check  Wells Fargo
No other personal checks will be accepted. Make payable to: Brenda Nelson-Porter

Amount Enclosed:

VIII. Terms

I hereby apply for certification from the Firm as a qualified applicant and swear that all statements made by me in this application, to the best of my knowledge, are true and factual. I understand that proofs of my PDCs, which must accompany this application, may be verified.

I understand the examination will be administered by a proctor secured by the applicant. I further understand the examination will not exceed two (2) hours. I understand the proctor will mail the completed examination to the Firm.

I understand that there will be no refunds if and after this application has been approved and there are no guarantees that I, the applicant, will pass the examination.

I understand that obtaining a Designation offered by the Firm will not guarantee a loan, employment, contract, and/or clientele.

I understand if any information is falsified on this application, it can result in my certification being revoked without a refund. I further understand that violation of standard business and research ethics will result in either termination of the designation or nonrenewal of the certification.

I understand that the completed exam (test) will not be returned to the applicant. Only the final score will be sent to the applicants. The Firm holds the right to protect the content of the exam.

The applicant further understands any legal disputes associated with this application and processes has to be mitigated in the State of Georgia (Newnan).

My signature below affirms that I agree to the terms stated above.  I have also read, understand, and agree to all terms and conditions of the certification programs as explained on the Firm's certification web pages.

Applicant's Signature: _______________________________________________     Date: