Partnership Application Form

Type of Application(Required)

Name(Required)

First Middle Last

Title(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Phone(Required)

List of Additional Authorized Trainers with Brief Description of Experience:(Required)

Authority to Apply. Provide a copy of the resolution by the Board of Directors, Board of Regents, company president, Chief Executive Officer or other governing body of the organization approving the submittal of an application to the NASP/IASP to become an NASP/IASP franchisee.

Incorporation Status:(Required)

INCLUDE EVIDENCE OF INCORPORATION INCLUDING NATION (AND STATE, IF APPROPRIATE) AND LICENSING IF REQUIRED IN YOUR REQUESTED REGION.

Occupational Safety and Health Training Experience:(Required)

DEMONSTRATE PREVIOUS EXPERIENCE DELIVERING OCCUPATIONAL SAFETY AND HEALTH TRAINING TO ADULTS

Status as a Training Organization(Required)

(THIS APPLIES ONLY TO APPLICANTS THAT ARE NOT COLLEGES OR UNIVERSITIES.) DOCUMENT THAT TRAINING OR EDUCATION IS THE PRINCIPAL ACTIVITY OF THE ORGANIZATION.

Curriculum Development:(Required)

EXPLAIN THE ORGANIZATION'S PROCESS AND EXPERIENCE FOR DEVELOPING AND UPDATING OCCUPATIONAL SAFETY AND HEALTH TRAINING.

Training Facilities:(Required)

PROVIDE DETAIL INFORMATION REGARDING CLASSROOMS, LABORATORIES, AND TESTING FACILITIES AVAILABLE - INCLUDE TRAINING ADDRESS(ES); AND ORGANIZATION'S ABILITY TO PROVIDE STANDARD CLASSROOM TRAINING ACROSS THE REQUESTED REGION.

Projected Effect:(Required)

PROJECT THE NUMBER OF STUDENTS TO BE TRAINED IN NASP/IASP COURSES FOR EACH OF THE FIRST THREE YEARS OF OPERATION. INCLUDE PROPOSED COURSES TO BE TAUGHT. PROVIDE GEOGRAPHICAL EXTENT FOR THESE PROJECTIONS (WHAT GEOGRAPHIC AREA ARE YOU REQUESTING FOR FRANCHISE?)

Project the Gross Income from NASP/IASP Courses During the First Three Years of Operation:(Required)

Composition of Company Offerings: Will This Company Offer For Sale Training Courses, Services, or Products Other Than Those Provided by NASP/IASP?(Required)

Yes

If so, Thoroughly Explain. (Explain how you will insure that offering NASP/IASP courses will not negatively impacted by your other offerings)(Required)

$200.00

Credit Card Number:(Required)

Name on the Credit Card:(Required)

Partnership Fee

Total