ENROLLMENT FORM
COMMISSIONERS OF THE REVENUE/DEPUTIES
CAREER DEVELOPMENT PROGRAM
NAME (AS YOU WANT IT TO APPEAR ON YOUR CERTIFICATE)
Mr.
Mrs.
Ms.
Last Name
First
Commissioner
Deputy Commissioner
Middle
Date began in office (MM/DD/YY)
Social Security Number (LAST 4 DIGITS)
CRAV member since (MM/DD/YY)
OFFICE INFORMATION
City
County
Town
Locality
Physical Address
City
State
Phone
Fax
Zip Code
E-mail
SERVICE TO COMMISSIONERS OF THE REVENUE ASSOCIATION OF VIRGINIA
Please list any officer position, including district chairman and all committees, which you have been chairman or a member of since
January 1, 1998. (SEE CAREER DEVELOPMENT HANDBOOK FOR COMMITTEES THAT QUALIFY.)
Please list any presentations you have given at eligible conferences since January 1, 1998. (SEE CAREER DEVELOPMENT HANDBOOK
FOR CONFERENCES THAT QUALIFY.)
EDUCATION
Highest level of education completed:
High School/GED
Business School
Associate
Bachelor’s
Law/Master’s
Where did you earn your degree?
Year
In what field is your degree?
Please list all IAAO courses taken and passed; give course number and grade.
COURSE NAME &/NUMBER
DATE (MM/YY)
LOCATION
GRADE
Please list the dates (MM/YY) you attended the conferences listed below:
_______________________________ Compensation Board/COR Training for New Constitutional Officers
_______________________________ Compensation Board/COR Training Program for Deputies
_______________________________ Association’s Annual Meeting
_______________________________ CRAV/TAV Joint Education Conference
_______________________________ District Meetings
_______________________________ Income Tax Workshops (Department of Taxation)
_______________________________ VAAO Education Seminar or Annual Meeting
_______________________________ Workshops on Real/Personal Property (Department of Taxation)
_______________________________ VALECO Annual Meeting
_______________________________ VA Association of Local Tax Auditors (VALTA)
_______________________________ IAAO Workshops/Seminars (no IAAO courses)
_______________________________ Other Meetings/Seminars/Workshops (IAAO, ASA, etc.)
WORK EXPERIENCE
List the positions you have held, beginning with the most recent. Include the month and year of experience.
EMPLOYER
LOCATION
DATES
TITLE
DUTIES
I affirm that the information given on this application is true and correct and I am enclosing my check for
$75 made payable to the University of Virginia.
Signature
Date
Please return form to: Weldon Cooper Center for Public Service
Beth Watson
P.O. Box 400206
Charlottesville, VA 22904-4206
Questions? Call (434) 982-2144.
OFFICE USE ONLY
Certification Date __________ Date Paid __________ Check # __________ Amount Paid __________