Technology Training Registration Form
Street Address Line 2
State / Province
Postal / Zip Code
Can we text you with updates about the program to your phone?
Do you have regular access to a laptop or desktop device?
Do you have regular access to internet?
Are you currently employed?
Currently Not Employed
Currently In School
Select Your Highest Level Of Education
2 Yr College (Assoc. Degree)
4 Yr College (BA/BS Degree)
Professional Degree (MD, JD, etc.)
Select Which Course You Would Like to Register For:
IT Essentials/IT Support Training
Data Analytics - SQL Training
How did you hear about this program?
Social Media (Facebook, Instagram, etc.)
AMPED Staff or Board Member
News or Online Ad
Participated in AMPED Program in Past
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?
List any previous IT Training you have received
Please verify that you are human
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