Technology Training Registration Form
Full Name
*
First Name
Last Name
E-mail
*
example@example.com
Phone Number
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Gender
Male
Female
Transgender
Non-binary/non-conforming.
Prefer not to respond.
Can we text you with updates about the program to your phone?
Yes
No
Do you have regular access to a laptop or desktop device?
*
Yes
No
Do you have regular access to internet?
*
Yes
No
Are you currently employed?
*
Full-Time
Part-Time
Currently Not Employed
Currently In School
Select Your Highest Level Of Education
High School/GED
Some College
2 Yr College (Assoc. Degree)
4 Yr College (BA/BS Degree)
Masters Degree
Doctorial Degree
Professional Degree (MD, JD, etc.)
Other
What is your current salary?
$0 - $20,000
$20,001 - $45,000
$45,001 - $60,000
$60,001 - $80,000
$80,001 - $100,000
$100,000 +
What is your Desired salary range?
$0 - $20,000
$20,001 - $45,000
$45,001 - $60,000
$60,001 - $80,000
$80,001 - $100,000
$100,000 +
Select Which Course You Would Like to Register For:
*
IT Essentials/IT Support Training
Data Analytics - SQL Training
Cybersecurity
How did you hear about this program?
Website
Social Media (Facebook, Instagram, etc.)
AMPED Staff or Board Member
AMPED Event
News or Online Ad
Participated in AMPED Program in Past
Other
Why are you interested in this program?
*
What are you looking to learn and takeaway from this course?
*
Which times of day work best for you for instruction?
Morning
Daytime
Evening
List any previous IT Training you have received
Please verify that you are human
*
Submit
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