NICA CCE Application

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Date* This field is required.
Month
Day
Year
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Applicant Name:* This field is required.
First Name
Last Name
3
Phone Number:* This field is required.
Area Code
Phone Number
4
Email:* This field is required.
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Name of Business:* This field is required.
6
Business Address:* This field is required.
Street or PO Box Address
Street or PO Box Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
7
Have you ever been convicted of a felony?* This field is required.
Yes
No
8
If yes, please explain:
9
Experience as an Operating Manager* This field is required.
10
Total Points for Category 1:* This field is required.
15 Points for the first five years and 1 point for each additional year (Minimum of 17 points – Maximum of 25 points)
11
High School Attended:
GED or High School Graduate: 5 Points
12
Year Graduated:
13
Points:
14
College or University Attended:
15
Degree(s) Received:
Each degree received: 5 Points
16
Year Graduated:
17
Points:
18
Number of Credit Hours Earned (if no degree):
Every 30 Semester Hours or 45 Quarter Hours: 1 point
19
Points:
20
Accredited Adult Education courses, correspondence, business or other accredited courses:
Name of Course(s) and Institution(s)
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Points:
22
Total Points for Category 2:* This field is required.
Minimum of 5 points – Maximum of 10 points
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Work Experience in Concession Business(es)* This field is required.
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Total Points for Category 3:* This field is required.
25
A) State and/or Province Association Meeting(s):* This field is required.
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Points:
2 points per meeting attended per year (within the last five years)
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B) CAFE, IAFE, IFEA, and/or WFA Annual Convention(s):* This field is required.
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Points:
2 points per convention attended per year (within the last five years)
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C) Zone Meeting(s) or Seminar(s) at Non-Convention Times:* This field is required.
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Points:
2 points per meeting or seminar attended per year (within the last five years)
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D) NICA Annual Meeting, Food Show or Education Seminar(s):* This field is required.
32
Points:
2 points per meeting, food show, or seminar attended per year (within the last five years)
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Total Points for Category 4:* This field is required.
Within the last 5 years. Minimum of 15 points – Maximum of 25 points
34
A) NICA, CAFE, IAFE, IFEA, WFA, or State or Province Association Committee Member:* This field is required.
35
Points:
1 point for each Committee, each year 1 point extra if Chair (within the last five years)
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B) NICA National Representative and/or Council Member & Year(s) Active:* This field is required.
List States Represented if National Representative; list Council if Council Member • 2 points (within the last five years)
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Points:
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C) NICA, CAFE, IAFE, IFEA, WFA, or State or Province Association Annual Convention, NICA Education Seminar, Speaker, Panelist or Table Topic Leader:* This field is required.
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Points:
2 points for each year (within the last five years)
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D) Program participant at NICA, CAFE, IAFE, IFEA, WFA or State or Province Association Meeting or Seminar:* This field is required.
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Points:
2 points for each year (within the last 5 years)
42
E) Membership in Allied Association (CAFE, IAFE, IFEA, OABA, WFA, State or Province or Other Association):* This field is required.
43
Points:
1 point for each Association (within last five years)
44
F) Served as Associate Representative:* This field is required.
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Points:
2 points for each Organization (within last five years)
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G) Established Communications Committee at an event without one:* This field is required.
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Points:
5 points for each Committee formed (within last five years)
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H) Participated on Communication Committee:* This field is required.
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Points:
2 points for each Committee participation (within last five years)
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I) Participated in NICA Meetings THIS year:* This field is required.
51
Points:
1 point for each meeting – Maximum 5 points
52
J) Submitted at least one story to NICA News (or any other trade publication):* This field is required.
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Points:
2 points for each article
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K) Encouraged 10 or more new members to Join NICA, IAFE, IFEA, WFA or State or Province Associations:* This field is required.
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Points:
1 point for each new member
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L) Organized/participated in a fundraiser sanctioned by NICA within the last 5 years:* This field is required.
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Points:
2 points each for participation – 5 points each for serving as chair
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M) Name of civic or community organization in which you are a member or have contributed to in the last 5 years, i.e. Chamber of Commerce, Farm Bureau, Service Clubs such as Rotary, Kiwanis, Jaycees or others; 4 H; FFA; Girl/Boy Scouts; YMCA/YWCA; or other recognized civic service or fraternal organization & Year(s) Active:* This field is required.
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Points:
1 point per organization per year (only in last five years)
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Total Points for Category 5:* This field is required.
Minimum of 25 points – Maximum of 40 points
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Total Points for Category 6:* This field is required.
Minimum 5 points – Maximum 10 points
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List Event Name(s) and indicate some flat, some percentage* This field is required.
63
Total Points
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Personal References* This field is required.
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Event References* This field is required.
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Business References* This field is required.
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Write a statement of 150 – 200 words (minimum) giving your philosophy of communications and management of your business as it relates to the Fair Industry:* This field is required.
68
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Applicant Signature* This field is required.
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Enter the message as it's shown* This field is required.
71
Administrative Fee* This field is required.
I agree to pay the $90 Administrative Fee via phone or mail to the NICA Office in order to process my CCE application.
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