PTCB Sponsorship Program Application

Please note that to participate in the PTCB sponsorship system, you must already be a member of either the Advocate Educator or Advocate Employer program.


Each Sponsor must represent a single educational institution, a single campus if part of a large institution, or a single employer. Duplicate sponsor applications will not be accepted. This application must be completed and signed by an authorized representative of the identified applicant institution.

Primary Contact Information

First Name

Middle Name [optional]

Last Name

Organization / Educational Institution

Country [optional]

Street Address 1

Street Address 2 [optional]

City

State/Province

Zip/Postal Code

Telephone

Email Address

Has your organization enrolled in the PTCB Educator Program or Employer Partnership Program?


Campus, Store or District Name. If none, enter 'Not Applicable'

Accounting Contact Information

First Name

Middle Name [optional]

Last Name

Country [optional]

Street Address 1

Street Address 2 [optional]

City

State/Province

Zip/Postal Code

Telephone

Email Address

Sponsor Information

Please choose a method of sponsorship for your organization (only one may be selected): [optional]





Sponsors have the option to require two additional fields for identification purposes. Select the first. [optional]







If other please specify [optional]

Sponsors have the option to require two additional fields for identification purposes. Select the second. [optional]







If other please specify [optional]

How did you hear about the PTCB Sponsor Partnership Program? [optional]







If other please specify [optional]

Applicant Representative's Name

Company

Date (enter in mm/dd/yyyy format)