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 proofread courseworks ►Conduct 3 In-Person visits ►Assist in submitting application for endorser visit ►Fulfill advisor role is valid for 1 year. Credential candidates who exceed their completion date will be responsible in finding their own advisor to continue working with them. Additional fee of $ 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 ►Do virtual visits. All advisor visits are done in-person ►Tolerate misconduct and disrespect. Payment Method*SelectACHCheckConsent Yes I understand that: • Cost is $50/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.NameThis field is for validation purposes and should be left unchanged.
