2018 Applicant Intent to Apply Form Application Level 1, 2, and 3 2018 Award Process
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2018 Applicant Intent to Apply Form Application Level 1, 2, and 3 2018 Award Process This is a fill-in enabled form. It can be completed electronically. This form is to be submitted by all Level 1, 2, and 3 Applicants. Mail the completed Intent Form and the $150 Intent Fee to the MAAPE Office; it must be postmarked by January 5, 2018. Additional instructions are provided in Section II of this form. If you have any questions, please call us: 717-737-6470. MAAPE Mailing Address: Mid-Atlantic Alliance for Performance Excellence Award Process 590 Centerville Road #260 Lancaster, PA 17601
Organization Name as it will appear on Award Initial the above box if you choose not to receive recognition at the Annual MAAPE Awards Banquet Address
City State Zip
Name
Title
Mailing Address Street Address (no PO Box) City State Zip Telephone Fax E-mail
6. Alternate Official Contact Name
Telephone Fax
E-mail
7. Returning Applicant? Yes No Application Year(s): 8. Highest Ranking Official Name
Title
Address
City State Zip
Telephone Fax E-mail
9. Application Level Check one: Description of Application Level 1 Organizational Profile and 15 page Category-Level Application Level 2 Organizational Profile and 50 page Item-Level Application Level 3 Organizational Profile, 50 page Item-Level Application, and Site Visit Level 3 Site Visit Weeks Level 3 applicants must indicate 1st and 2nd choice for Site Visit Weeks Indicate 1st & 2nd Choices: July 9, 2018 July 16, 2018 Level 3 Education applicants should contact MAAPE if an alternate Site Visit Week is required to work within the school calendar. Please visit the MAAPE website for: Fees associated with each Application level The level of recognition available to Applicants at each Application Level Organizations are judged within their respective sectors of Education, Government, Health Care, Manufacturing, Not for Profit, and Service. Any number of organizations may receive Recognition or Excellence Awards in each year. 10. Nomination of Examiners (required for all Applicants) Application Level Examiner Requirement - Check one and enter the name(s) Level 1 1 Examiner Name: Level 2 1 Examiner Name: Level 3 2 Examiners Names: NOTE: ALL Examiners will be required to complete pre-work and a 3-day, in-class training course. A series of four webinars will be conducted in January and February to assist examiners in completing their pre-work and preparing for the in-class training. Three in-class sessions will be offered in late February through March at locations in Eastern and Western PA and in NJ. See the MAAPE website for additional information. 11. One-Sentence Organization Description Please provide a brief description of your organization to be used for publicity and recognition. 12. Applicant's Statement and Authorizing Signature We certify that our organization meets the eligibility requirements of the Mid-Atlantic Alliance for Performance Excellence Award and the sector in which we intend to apply. We understand that members of the Board of Examiners will review this application. We agree to participate in the evaluation process, to facilitate an open and unbiased examination, and to reimburse expenses incurred by the site visit team (Level 3 applicants only). We understand MAAPE’s expectations of us as an Applicant to share our successful improvement strategies and lessons from our performance excellence journey with other Pennsylvania, New Jersey and Delaware organizations, to participate in the annual MAAPE Conference, and to use appropriate methods to communicate and advertise recognition received through the MAAPE Award Process. Signature of Highest Ranking Official: _____________________________________________ Date: _____________________________________________ 13. Intent Fee and Mailing Address Enclose $150 Intent Fee (non-refundable) made payable to MAAPE to cover initial processing. Mailing Address: Mid-Atlantic Alliance for Performance Excellence Award Process 590 Centerville Rd., # 260 Lancaster, PA 17601
Use these fields to provide the official name of the organization as it will appear on the Award and on publicity materials. 2. Size and Locations Provide the number of full-time equivalent employees (FTE) working at the organization and the number working in Pennsylvania, New Jersey and Delaware. Full-time equivalent employees are defined as those who regularly work 40 or more hours a week and are entitled to benefits such as paid vacation, sick leave and insurance coverage. Each instance of job sharing, where multiple individuals fulfill the responsibilities of a single position that requires 40 or more hours per week, is counted as a full-time equivalent employee. MAAPE defines small, medium, and large organizations as follows: Small: Less than 100 total employees in the unit applying Medium: 100 to 500 total employees in the unit applying Large: More than 500 total employees in the unit applying Indicate the percent of the organization's total assets located in Pennsylvania, New Jersey and Delaware. Indicate the number of sites to be included in the evaluation. 3. Industry Sector Please select the sector that best describes your organization. This information will determine the Criteria MAAPE will use to evaluate your application. 4. Industrial Classification Insert North American Industry Classification System (NAICS) codes most relevant to the organization’s products and/or services (see Section III of this form for a complete list of codes). 5. Official Contact In these fields, provide complete contact information (using a street address for courier deliveries) for the person at the organization who can provide additional information and arrange a site visit. 6. Alternate Official Contact In the event the official contact is not available, please provide contact information for an alternate contact with the authority to provide additional information or arrange a site visit. If the official or alternate contact changes during the course of the application process, please inform MAAPE. 7. Return Applicant Indicate if the organization is a return applicant and if so, year(s) of previous application(s). 8. Highest Ranking Official In these fields, provide information about the organization’s highest-ranking official (e.g., owner, CEO, president, chairperson, plant manager). 9. Identify Application Level Please choose the level of recognition for which your organization is applying. See level descriptions on the MAAPE web site. 10. Examiner Requirement All applicants are required to provide Examiners for the Award Process, both to enhance your organization's understanding of the Baldrige Excellence Framework, and to ensure adequate resources for Application evaluation. Please review Examiner responsibilities on the MAAPE website to help you to select the appropriate individual(s). List the name(s) of the individual(s) in this section and ask the individual(s) to submit an Examiner Application, also available on the MAAPE website. Please note that if you do not provide the required number of Examiner nominees, or an Examiner nominee does not complete Examiner Training, your organization’s Award Application will not be accepted. If an Examiner nominee completes Examiner Training, but does not participate in the Award Process as an Examiner, MAAPE will assess your organization an additional $500 fee. 11. One-Sentence Description Provide a brief description of your organization. This description will be used in conjunction with the MAAPE Awards Banquet and for publicity purposes. 12. Signature of Highest Ranking Official This form should be signed by the Highest Ranking Official listed in Section 8. 13. Intent Fee and Mailing Address A $150 non-refundable Intent Fee is required to cover the costs associated with the initial processing. The Intent Fee may be paid by check. Submit your payment with the Intent Form. Submitting your Intent to Apply PacketYour Intent to Apply Packet should include: Two copies of the Intent to Apply Form $150 Intent Fee Mail these items to the Mid-Atlantic Alliance for Performance Excellence, postmarked by January 5, 2018: Mid-Atlantic Alliance for Performance Excellence Award Process 590 Centerville Road #260 Lancaster, PA 17601 Section III: North American Industry Classification System (NAICS) Codes Please insert the NAICS codes most relevant to your organization’s products and/or services on Section I of your Application form. Code/Sector 111 Crop Production 112 Animal Production 113 Forestry and Logging 115 Support Activities for Agriculture and Forestry
211 Oil and Gas Extraction 212 Mining (except Oil and Gas) 213 Support Activities for Mining 221 Utilities 236 Construction of Buildings 237 Heavy and Civil Engineering Construction 238 Specialty Trade Contractors 311 Food Manufacturing 312 Beverage and Tobacco Product Manufacturing 313 Textile Mills 315 Apparel Manufacturing 316 Leather and Allied Product Manufacturing 321 Wood Product Manufacturing 322 Paper Manufacturing 323 Printing and Related Support Activities 324 Petroleum and Coal Products Manufacturing 325 Chemical Manufacturing 326 Plastics and Rubber Products Manufacturing 327 Nonmetallic Mineral Product Manufacturing 331 Primary Metal Manufacturing 332 Fabricated Metal Product Manufacturing 333 Machinery Manufacturing 334 Computer and Electronic Product Manufacturing 335 Electrical Equipment, Appliance and Component Manufacturing 336 Transportation Equipment Manufacturing 337 Furniture and Related Product Manufacturing 339 Miscellaneous Manufacturing 423 Merchant Wholesalers, Durable Goods 424 Merchant Wholesalers, Nondurable Goods 425 Wholesale Electronic Markets and Agents and Brokers 441 Motor Vehicle and Parts Dealers 442 Furniture and Home Furnishings Stores 443 Electronics and Appliance Stores 444 Building Material and Garden Equipment and Supplies Dealers 445 Food and Beverage Stores 446 Health and Personal Care Stores 447 Gasoline Stations 448 Clothing and Clothing Accessories Stores 451 Sporting Goods, Hobby, Book and Music Stores
452 General Merchandise Stores 453 Miscellaneous Store Retailers 454 Nonstore Retailers 481 Air Transportation Code/Sector 482 Rail Transportation 483 Water Transportation 484 Truck Transportation 485 Transit and Ground Passenger Transportation 487 Scenic and Sightseeing Transportation 488 Support Activities for Transportation 491 Postal Service 492 Couriers and Messengers 493 Warehousing and Storage 511 Publishing Industries (except Internet) 512 Motion Picture and Sound Recording Industries 515 Broadcasting (except Internet) 516 Internet Publishing and Broadcasting 517 Telecommunications 521 Monetary Authorities — Central Bank 522 Credit Intermediation and Related Activities 523 Securities, Commodity Contracts and Other Financial Investments and Related Activities 524 Insurance Carriers and Related Activities 525 Funds, Trusts and Other Financial Vehicles 531 Real Estate 532 Rental and Leasing Services 533 Lessors of Nonfinancial Intangible Assets (except Copyrighted Works) 541 Professional, Scientific and Technical Services
551 Management of Companies and Enterprises 561 Administrative and Support Services 562 Waste Management and Remediation Services
611 Educational Services 6111 Elementary and Secondary Schools 6112 Junior Colleges 6113 Colleges, Universities and Professional Schools 6114 Business Schools and Computer and Management Training 6115 Technical and Trade Schools 6116 Other Schools and Instruction 6117 Educational Support Services Continued on next page> Code/Sector 621 Ambulatory Health Care Services 6211 Offices of Physicians 6212 Offices of Dentists 6213 Offices of Other Health Practitioners 6214 Outpatient Care Centers 6215 Medical and Diagnostic Laboratories 6216 Home Health Care Services 6219 Other Ambulatory Health Care Services
622 Hospitals 623 Nursing and Residential Care Facilities 624 Social Assistance 711 Performing Arts, Spectator Sports, and Related Industries 712 Museums, Historical Sites and Similar Institutions 713 Amusement, Gambling and Recreation Industries 721 Accommodation 722 Food Services and Drinking Places 811 Repair and Maintenance 812 Personal and Laundry Services 813 Religious, Grantmaking, Civic, Professional and Similar Organizations 814 Private Households 921 Executive, Legislative and Other General Government Support 922 Justice, Public Order, Safety Activities 923 Administration of Human Resource Programs 924 Administration of Environmental Quality Programs 925 Administration of Housing Programs, Urban Planning and Community Development 926 Administration of Economic Programs 927 Space Research and Technology 928 National Security and International Affairs 999 Unclassified Establishments Mid-Atlantic Alliance for Performance Excellence 2018 Intent to Apply Form for Levels 1, 2, and 3 717-737-6470• midatlanticape.org page Directory: images -> downloads downloads -> Damon Lembi downloads -> Sigchi conference Proceedings Format downloads -> Cad: 10K hrs catia., 3K (also V3, V4, enovia, vpm) Very good with cad and spatial relations downloads -> 2016 shrm affiliate program for excellence (shape) – chapter planning worksheet downloads -> Walton College of Business, University of Arkansas downloads -> Improved text messaging system – and you can help the school save money downloads -> Name Dr. Archana Mantri Areas of interest & Current Research focus downloads -> Category a- supply and delivery of goods downloads -> Judaica library accreditation due Date: Tuesday, January 12, 2016 Please fill out this form on a computer; it should not be handwritten downloads -> Richard G. Stefanacci, do, mgh, mba, agsf, cmd Download 76.62 Kb. Share with your friends:
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