Course Registration Form

Student Registration Form

Fill out the form carefully for registration to attend a computer training.
Student Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Gender*
Race*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What Ward do you live in?*
Student E-mail*
example@example.com
Mobile Number*
Phone Number*
Company
What government benefits are you currently receiving?*

SSISocial SecurityUnemploymentTANFStay DCOther
Are you able to commit to attending the 16 week course M-F 9am-5pm?*
What courses do you wish to register for?*

Microsoft Word BasicsMicrosoft Excel BasicsMicrosoft PowerPoint BasicsInternet BasicsHow to Increase Your Credit ScoreHow to Pay Off DebtHow to Track Spending
Do you have access to a computer?*
Do you have access to the internet*
Additional Comments*
Explain why you want to take the course.
Upload Proof of Identity (drivers license, non drivers license id, passport)*

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Upload Proof of Income. A determination Letter is not accepted as proof of income. (benefit check, bank statement, unemployment benefit statement, SSI/social security benefit statement)*

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Should be Empty:

Student Registration Form