Pro Bono Group (PBG) Mentor or Advisor Application

Please complete the information below: Your name and address exactly as you wish it to appear in NACVA’s Pro Bono Group Member Directory. To better serve you, NACVA requests a business photo (head shot) be submitted along with your application and CV which can be uploaded at the end of this document.

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Your Information:

Name:

NACVA Member #:

Firm Name:

Designations:

Address:

City:

State:

ZIP:

E-mail Address:

Phone Number:

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I am currently a Practitioner member in good standing with NACVA and have (check applicable):

10+ years’ experience for Mentor;

5+ for Apprentice in financial forensics and/or business valuation.

Professional Status/Conduct: (The following four questions MUST be answered to complete your Application)

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If you are a CVA, do you hold a current CPA License?

Yes

N/A

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Have you ever been convicted of any felony or crime carrying a punishment of time in prison, whether or not time was served?

Yes

If yes, please explain:

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Have you ever been convicted of a misdemeanor involving moral turpitude (lying, cheating, stealing, or other dishonest conduct) or any equivalent crime in any court of law?

Yes

If yes, please explain:

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Have you ever had any professional license, professional certification, or professional membership revoked, refused, or suspended (other than for non-payment of dues)?

Yes

If yes, please explain:

NACVA reserves the right to refuse Pro Bono Group participation to any person. A NACVA member and/or designee holding a NACVA certification may have his or her membership or certification revoked given appropriate grounds and/or standards violations, as determined by the Ethics Oversight Board.