Digital Literacy Registration Form

Student Registration Form

Fill out the form carefully for registration. In order to participate in these FREE classes you will be required to complete a Student Information Pre & Post Assessment. Classes start 11/29/22 - 1/18/23 Tues, Wed, Thurs 9am - 12pm. Google Certification is available.
Student Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Gender*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student E-mail*
example@example.com
Mobile Number*
Phone Number
How did you hear about class
Should be Empty:

Student Registration Form