Skip to content
Click here to
Donate
Home
PENW Program
Building Blocks
Application
Timetables and Fees
About us
Baldrige Excellence Framework
PENW Community
Award Recipients
Get Involved
Get PENW Examiner Training
Become an Examiner
Make A Contribution
Resources
Learning Library
Events
News
Partner Programs
Contact Us
Application Form test
Application Form test
Tim Johnson
2019-07-19T14:44:25-07:00
2018 PENW Examiner Application Form
Thank you for your interest in participating in a nationally-recognized group of leaders for Baldrige-based training as an examiner of applications for the Washington State Quality Award program and Performance Excellence Northwest. Your involvement in the excellence journey provides a valuable service to the region (Washington, Oregon, Idaho and Alaska). If you are an expert in business, education, healthcare or nonprofits/government and possess experience in most of the Baldrige categories (namely, leadership; strategy; customers; measurement, analysis and knowledge management; workforce; operations; and results), we encourage you to complete this application and join PENW’s board of examiners.
Individual Information
Title
Title
Mr.
Ms.
Dr.
Name
*
First
Last
Primary Email
*
List Alternate Email
Alternate Email (optional)
Primary Phone Number
*
List alternate number
Alternate Phone Number (optional)
Address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Employmemt Information
Name of Employer
*
Title / Position
*
Employer's Email Address
*
Employer's Phone Number
*
Employer's Mailing Address
*
Street Address
Address Line 2
City
Sate
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Number of Years with this employer
*
Number of Years in this business
*
Number of Years in this Industry
*
What Sectors
Select All
Business
Business, small
Business/Government
Health Care
Education
Parent Company (if appliatble)
Experience
Previous Experience
If you have served as an examiner for Baldrige or in a similar assessment process, indicate your prior experience. Include the name of the program and no. of years served:
PENW
BPEP (National)
Others
Earned Degrees / Certificates
Type of Degree
Field of Study
School or Institute
Please list Degrees or Certificates you have earned. Click button at the end of row to generate more inputs as you need.
Skill Sets and Goals
Sector Expertise
Business
Small Business
Service Business
Government
Education
Healthcare
Manufacturing
By clicking and dragging list the selections below in order of your level of expertise start with most proficient on top
Preferred Roles
Examiner
Team Lead (this is available only to returning examiners)
Back up Team Lead (support lead in organization, work assignments, time management)
Scorebook editor
Identify the roles you would be interested and comfortable in performing
Criteria Expertise
No Experience
Little Experience
Proficient
Expert
Leadership
Strategic Planning
Customer Focus
Measurement, Analysis, Knowledge Management
Work Force Focus
Operations Focuse
Organizational Results
Indicate your perceived level of ability to assess the seven criteria in the Baldrige framework. Rate yourself based on the following scale:
For Lead/Returning Examiners only
1
2
3
4
5
6
7
Leadership
Strategic Planning
Customer Focus
Measurement, Analysis, Knowledge Management
Work Force Focus
Operations Focuse
Organizational Results
Rate your level of interest from 1 to 7 where:
Fees and Schedules
Examiner Training
Early Bird Fee: $199
Registration after Nov.1: $300
New examiners are required to participate in training which is conducted over three days in the Seattle and Portland areas each year. If you do not think you will be able to participate in training for any reasons this year, please indicate the reason. Otherwise, if you meet the qualifications for examiner training, you will be notified of the next available training date and location.
Next Examiner Workshop
Available first week of site visit (last week of Apr 2019)
Available second week of site visit (first week of May 2019)
Not available
2018 Examiner Workshops are planned for Idaho, Washington and Alaska in 2018. Refer to the Schedule page or contact AskUs@PerformanceExcellenceNE.org.
Employees per Fees
Lite: 01-50 $885.00 USD
Lite: 51-250 $1,500.00 USD
Lite: 251-500 $2,200.00 USD
Lite: 501+ $2,800.00 USD
Full: 01-50 $1,500.00 USD
Full: 51-250 $3,500.00 USD
Full: 251-500 $5,000.00 USD
Full: 501+ $6,200.00 USD
