Name:      Birth Date:
Business Name:       Title: 
Industry:      Years in this Profession:   
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

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 hope this Designation will improve your future endeavors:
How do you hope this Designation will improve your future endeavors?
 

Certification Information (select one):

  Certified Executive Scholar (CES)© Designation Examination

  Certified Enterprise Researcher (CER)© Designation Examination

I. Certified Executive Scholar © Designation Exam

a. Criteria:
       Answer an online questionnaire: http://www.brigettes.com/NewRealityCorporationConcept/Executive.htm
       or http://www.brigettes.com/NewRealityCorporationConcept/ManagerDirector.htm
       Hold the designation: Doctor  (e.g., Ph.D., MD, DM, Ed.D., and so forth) or Doctoral Candidate
       Participated in a minimum of 2 projects for scholars:   and
      

b. Cost:
       $3,000.00  5-year designation

c. Recertification Cost:

         $500.00  Extended 5-year designation

II. Certified Enterprise Researcher© Designation Exam

a. Criteria:
       Answer an online questionnaire: http://www.brigettes.com/NewRealityCorporationConcept/Executive.htm
       or http://www.brigettes.com/NewRealityCorporationConcept/ManagerDirector.htm
       Hold the designation: Doctor  (e.g., Ph.D., MD, DM, Ed.D., and so forth) or Doctoral Candidate
       Participated in a minimum of 1 project for scholars

b. Cost:
       $2,000.00  5-year designation

c. Recertification Cost:

         $500.00  Extended 5-year designation

III. Practice Study Information

         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: Senior Executive (e.g., CEO, CKO, CIO, COO, and so forth, 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 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 the applicant's score is assigned by the Firm's grader. If failed a second time, the test cannot be ever took again by the applicant.

V. Recertification (after 5-year period)

CESs must earn 100 PDCs, and CERs must earn 70 PDCs by attending any related research-focused seminars or virtual seminars, such as product design, quality assurance, medical, chemistry, . Ten (10) PDCs will be granted for every seminars attended. Post doctorate courses will count for 10 PDCs. Include copy of certificates and/or highlighted transcripts.

VI. Acknowledgement

This designation was design by the Firm to to provide credibility to scholars who desire to be recognized in the industry as a potential client for outsourced initiatives.

VII. Payment

Payment Type Only:  Money Order Cashier/Official Check Corporate Check Bank of America Check  NFCU Check
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 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 employment, contracts, 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.

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 rules and conditions of the certification programs as explained on the Firm's certification web pages.

Applicant's Signature: ____________________________________________     Date: