Regional Representative Application Name Title Choose One Mr. Ms. Mrs. Prof. Dr. First Name * Last Name * Phone Number * Email Address * Name of School * Office Telephone Number of School * Name of Chief Administrator of School * Chief Administrator's Title * Administrator, Head of School, etc. School Address * School City * School State * School Zip * Educational Background, including years of experience in education * Number of Years’ Experience in the University-Model as an educator (3 required): * Have you been or are you a parent in the University-Model®? (not a requirement) * Yes No In a short paragraph, please describe your philosophical commitment to the University-Model® educational system and to University-Model Schools International, a division of NAUMS, Inc. * How many hours per week will you be available to work with the UM schools in your region (minimum of 5 hours required most weeks) * Compensation: Although we hope to increase compensation in the future, initially we will provide $1,000, payable in increments of $500 in July and December 2017. Will you be able to attend the mandatory training at the UMSI Summit, scheduled the week of June 26? If you have not yet registered for the Summit, and you are accepted as a regional representative, you will have the opportunity to register at the Early Bird rate. Please indicate in the comment section of this item if you have registered. School Requirement: Your school must be certified by NAUMS, Inc.. School Accreditation is preferred. Is your school certified by NAUMS, Inc.? * Yes No Is your school accredited? * Yes No If so, what agency? If not, is your school a candidate for accreditation? Yes No If not, have you applied or will you apply in the near future? Please note: The NAUMS, Inc. Board of Trustees is moving toward AdvancED Systems Accreditation, so experience in an accredited school will be an advantage for a regional representative. All details of your service to NAUMS, Inc. and UMSI will be covered during the Summit two-hour training. We strongly believe that attendance at the national conference is essential to the growth of this ministry, as well as to the growth of your school. Being involved in active unity with a group of like-minded Christians is powerful! Please list comments or questions: Electronic Signature Signature * Please type your first and last name. Date * I understand that checking this box confirms my signature and the information submitted in this form. * I agree. Deadline for receiving your Application is Friday, June 9. Please email questions to Barbara Freeman at bfreeman@umsi.org. Information Summary
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