Course Registration Form

Student Name *

First Name Middle Name Last Name

Birth Date *

Month Day Year

Gender *

Race *

Address *

Street Address

Street Address Line 2

City State / 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? *

SSI Social Security Unemployment TANF Stay DC Other

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 Basics Microsoft Excel Basics Microsoft PowerPoint Basics Internet Basics How to Increase Your Credit Score How to Pay Off Debt How 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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Student Registration Form