Registration Form For Advisory Program "*" indicates required fields Full Name* Email Address* Phone Number*Name of Organization* Name of Supervisor* Billing Address* Street Address Is this your 1st time applying for the advisory program?* Yes No. I previously have an advisor. Consent I understand that:Advisor duties are to: ►Mentor throughout the credentialing process ►Review and proof read courseworks ►Conduct 3 In-Person visits ►Assist in submitting application for endorser visit ►Advisor agreement is valid for 6 months. Credential candidates who exceed their completion date will be responsible for paying an additional fee to continue working with our Advisor. The New York State Network for Youth Success only allows for 2 years from the date of the start of class to complete the Credential Process. Advisor will not: ►Be responsible for assisting with classes ►Write and compile courseworks in your behalf ►Conduct additional visits without an agreement ►Constantly have to check on on coursework not being completed, this is the Candidate's responsibilityPayment Method*SelectACHCheckConsent Yes I understand that: • Cost is $65/hour. • Payment must be paid upon contract signing, and done via check or ACH. • Additional expenses for any visits outside of NYC will be shouldered by the credential candidate. • A contract will be provided and I will honor the clauses of the contact and comply accordingly.CommentsThis field is for validation purposes and should be left unchanged.
