Registration for Digital Campaigning Certificate Program
This form is designed to be completed by the registrant and their supervisor together, ideally before or at the same time as payment. It's to help set goals and expectations for successful completion of the program. If you can't identify someone who has some authority over how you spend your time, no worries, just complete the form yourself, or maybe with an important colleague in your work.

You will need to set up a 30-60 minute meeting to discuss and complete this together.

After clicking "Submit" you will receive an email that includes your responses as well as a link you can use to update those responses.

Half way through the program, the supervisor will participate in a required small group check-in conversation with SMT staff to celebrate progress and troubleshoot any issues with meeting the goals you've identified here.

Email address *
Your organization's name *
Your answer
Registrant's first name *
Your answer
Registrant's last name *
Your answer
Registrant's Title *
Your answer
Registrant's email *
Your answer
Supervisor's name/ or indicate why no name provided *
Your answer
Supervisor's email
Your answer
This course is both broad and deep. There are many ways to engage successfully with it. Have you checked out this spreadsheet that describes the options? http://bit.ly/CertificateOptions *
If there is a "department" track you as the registrant will be using as a guide for which topics you prioritize, which is it? (Just to be clear: we don't recommend these tracks since we think cross-training leads to better strategy. At the same time we recognize that sometimes it's necessary to prioritize.)
Which topics are highest priority for you and your organization? (check the top 5-10 in consultation with your supervisor and others as needed) *
Required
How important is it to either the registrant, or the supervisor, or to both of you, that the registrant get a Certificate that indicates a certain level of course completion?
Have you reviewed the options for levels of certification? You can tailor this course to meet the time you have and how deep you want to go. You can also change your plan! *
As the registrant, do you want to be teamed up with 2 other participants for the duration of the course so you can support and encourage each other? (If all three of you graduate with at least the minimum certificate requirements, you'll each get a Certificate "With Teamwork Distinction." We'll make an effort to pair you up with people roughly at your level.) *
For the purpose of being teamed up, what best describes your digital campaigning experience? *
Registrants who wish to earn a certificate are required to participate in at least 75% of the live sessions for the topics they are doing. Sessions are held 1-2:15pm EST (10-11:15am PST) on Wednesdays, twice a month September - July. What is the understanding about how this time will be protected by the registrant and by their supervisor? *
Your answer
What is the understanding about time to complete assignments? (Groups handle this all different ways, but it's important to have a clear understanding.) *
How will this learning process be extended and lifted up in the organization? (Check any that apply) *
Does the supervisor agree to participate in a small group check-in with other supervisors half way through the course to celebrate progress and troubleshoot any issues? *
Does the supervisor want to be added to the email list for the course so you have a heads-up about topics and what is happening in the course? You can expect about 1 email a week. *
Please check off that you understand: *
Required
Is there anything we should know? Any questions you have? Areas of deep expertise that you would be willing to share with the group?
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Social Movement Technologies. Report Abuse - Terms of Service