Please fill out the following application to attend the Business Academy. If you are interested to  become a Campus Ambassador and promote the Business Academy on your college campus and others, please also fill out the lower portion of this application.   Referral Information Referred By: SELECT Campus Ambassador Campus Career Center Entrepreneur Magazine LA Business Journal YPGN SIFE Search Engine Friend Other Referral Name:   Contact Information Prefix: SELECT Mr. Mrs. Ms. First Name: Middle Initial: Last Name: Suffix: Birth Date: Month January February March April May June July August September October November December Date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003     Street Name: Apt#: City: State: SELECT Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Washington D.C. Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Missouri Massachusetts Michigan Minnesota Mississippi Montana Nebraska North Carolina New Hampshire New Jersey New Mexico Nevada New York North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Other  Other:  Zip: Country: United States Andorra Argentina Australia Austria Bahamas Bahrain Bangladesh Belgium Benin Bermuda Bolivia Bosnia-hercegovina Botswana Brazil Brunei Bulgaria Cameroon Canada Chile Colombia Costa Rica Croatia Cyprus Czechoslovakia Denmark Ecuador Egypt El Salvador England Ethiopia Finland France French Polynesia Gambia Germany Ghana Greece Guatemala Guinea Honduras Hong Kong Hungary Iceland India Indonesia Iran Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kuwait Latvia Lebanon Liberia Liechtenstein Malaysia Mauritius Mexico Monaco Morocco N. Ireland Nepal Netherlands Netherlands Antilles New Zealand Nicaragua Nigeria North Korea Norway Pakistan Panama Paraguay Peoples Rep. China Peru Philippines Poland Qatar Rumania Russian Federation Saudi Arabia Scotland Senegal Sikkim Singapore South Africa South Korea Spain Sri Lanka Sudan Sweden Switzerland Taiwan Tanzania Thailand Trinidad&tobago Turkey Uganda Ukraine United Arab Emirates Uruguay Venezuela Vietnam W. Indies Federation Yugoslavia Zaire Zambia Zimbabwe Phone: Fax: Email: My website:   Education Information Undergraduate: Class: Freshman Sophomore Junior Senior Alumni Year of Grad: Major1: Major2: Minor1: Minor2: Comulative GPA: Professional Degree: Institution: Year of Grad: Concentration:   Desired Job Information (Optional) Desired Job: City looking for work in: State: SELECT Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Washington D.C. Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Missouri Massachusetts Michigan Minnesota Mississippi Montana Nebraska North Carolina New Hampshire New Jersey New Mexico Nevada New York North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Other  Other:  Country: United States Andorra Argentina Australia Austria Bahamas Bahrain Bangladesh Belgium Benin Bermuda Bolivia Bosnia-hercegovina Botswana Brazil Brunei Bulgaria Cameroon Canada Chile Colombia Costa Rica Croatia Cyprus Czechoslovakia Denmark Ecuador Egypt El Salvador England Ethiopia Finland France French Polynesia Gambia Germany Ghana Greece Guatemala Guinea Honduras Hong Kong Hungary Iceland India Indonesia Iran Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kuwait Latvia Lebanon Liberia Liechtenstein Malaysia Mauritius Mexico Monaco Morocco N. Ireland Nepal Netherlands Netherlands Antilles New Zealand Nicaragua Nigeria North Korea Norway Pakistan Panama Paraguay Peoples Rep. China Peru Philippines Poland Qatar Rumania Russian Federation Saudi Arabia Scotland Senegal Sikkim Singapore South Africa South Korea Spain Sri Lanka Sudan Sweden Switzerland Taiwan Tanzania Thailand Trinidad&tobago Turkey Uganda Ukraine United Arab Emirates Uruguay Venezuela Vietnam W. Indies Federation Yugoslavia Zaire Zambia Zimbabwe Willing To Relocate: Yes No Maybe Current Education: Some college Associates Degree Bachelor's Degree Master's Degree Doctorate Your Experience Level: 1-2 years 3-5 years 5-10 years 10+ Full Time: Part Time: Permanent: Contract: Job seeking in: Select Accounting/Finance/Banking Administrative/Clerical Creative Arts/Media Education/Training Engineering/Architecture/Design Human Resources Information Technology Legal/Law Enforcement/Security Marketing/Advertising Medical/Health Care Sales/Sales Management Travel/Hospitality/Restaurant Other Minimum Salary: US Authorized:   Professional Associations (Optional) Association1: Title:  Member since:  Association2: Title:  Member since:  Association3: Title:  Member since:    Apply to become a Campus Ambassador (Optional)   If you are interested to become a Campus Ambassador, please fill out the following questions. To upload your resume, click here. (if available)       In your opinion what is Entrepreneurial Leadership? (250 words or less)     As a Campus Ambassador and as a Business Academy attendee, you will be granted 1 year complimentary membership in YPGN. How can YPGN benefit from your membership and how can you benefit from YPGN membership?  (250 words or less)     If there is additional information you would like to provide, please use the space provided below. (250 words or less)   Thank you for filling out our application. The Business Academy's Organizing Committee will review your application and contact you shortly.