IT Leaders: IT Managers (ITM) Certificate Program 2024-2025 Cohort

Application For: IT Leaders 2024-2025 Cohort

IT MANAGERS (ITM) CERTIFICATE PROGRAM

Note: To be considered for the IT MANAGERS (ITM) Program, an employee must be nominated by their organization's CIO/IT Manager or other senior executive AND

have Mid to Upper Level Management classification; AND 2 years+ experience in IT operations or managing projects in the following core functional areas: application development, project management, computing and network, information systems security, or telecommunications.

Admission to the Program will be predicated on the approval of a candidate's sponsor/supervisor and Harrisburg University. Candidates will be accepted from all levels of government (federal, state, and local), private-sector, as well as the non-profit community.

PRODEV-Complete Registration & Contact Information

First Name *

Last Name *

Email Address *

Company/Employer *

Job Title/Occupation *

Street Address

Supplemental Address 2 (Primary)

Country (Primary) *

City (Primary) *

State/Province (Primary) *

Postal Code (Primary)

Phone-Phone (Primary)

GTI Application Data

Highest Level of Education Completed: *

Granting Institution: *

# of Years of Information Security Experience *

# of Years of Technical Experience *

# of Years of Managerial Experience *

How will participation in this program benefit your organization? *

How will participation in this program benefit other students? *

How will participation in this program benefit you? *

Supervisor/Sponsor's First Name *

Supervisor/Sponsor's Last Name *

Supervisor/Sponsor's Work Title *

Supervisor/Sponsor's Email *

I have read the attendance policy and understand that attendance is required in order to earn a certificate of completion. *

Yes

No

**If you are a Commonwealth of Pennsylvania (CWOPA/COPA) employee, please select your department/agency/bureau/commission/etc.

PA Commonwealth Departments

Delivery Center

Delivery Center *

Sector/Industry

Sector/Industry *

If Other, please specify sector and industry

How did you learn about this event/program?

How did you learn about this event/program? *

Source Name/Description

Data Collection: Harrisburg University will be collecting and storing your personal identification information regarding name, mailing address, email address, and telephone number, to contact you with additional information about this event and for future events that may be of interest. You will be given the option to opt out of communications regarding future relevant offerings.

Media Waiver: By submitting a registration for this event/course, I hereby grant permission to Harrisburg University (HU) and its representatives to take photographs or videos of me, including livestream, and to make recordings of my voice at this event. I further grant the right to reproduce, use, exhibit, display, broadcast and distribute. I acknowledge that HU owns all rights to the images and recordings, and I waive any right to royalties or other compensation arising from or related to the use of the images, recordings, or materials.

Cancellations: Harrisburg University reserves the right to cancel or reschedule/adapt courses/events at its discretion.

ADA Statement: HU is committed to providing equal education opportunity and full participation for persons with disabilities. It is HU’s policy that no qualified person be excluded from participating in any HU program or activity, be denied the benefits of any HU program or activity, or otherwise be subject to discrimination regarding any HU program or activity. Should you potentially require an accommodation under the ADA to participate in this program, please email ProfessionalEd@HarrisburgU.edu Please send your request for an accommodation at least 5 business days in advance of the event or program.

Harrisburg University of Science and Technology Federal ID# 25-1900793

IT Leaders: IT Managers (ITM) Certificate Program 2024-2025 Cohort