Media Arts Design certification program
Name:
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First Name
Last Name
E-mail Address:
Phone Number:
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Area Code
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Address:
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What program are you interested in? 1st Preference
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Adobe Photoshop (Ps) : 8 -weeks : $500 bonus*
Adobe Premiere Pro (Pr) : 8 - weeks : $500 bonus* :
Adobe After Effects (Ae) : 8-weeks : $500 bonus* :
What program are you interested in? 2nd Preference
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Adobe Premiere Pro (Pr) : 8-weeks: bonus* :
Adobe After Effects (Ae) : 8-weeks : bonus* :
Adobe Photoshop (Ps) : 8-wks : bonus*
How many years experience do you have?
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What is your level of experience in the listed areas of advice?
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None
Min. experience
Experienced
Very experienced
Adobe Photoshop (Ps)
Adobe Premiere Pro (Pr)
Adobe After Effects (Ae)
Please select your preferred days and times for your workshop schedule***
Tuesday evenings (5p-9p)
Thursdays evenings (5p-9p)
Education, Creative, Technical Skills & Training
Education Level
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High School
Some College
College Grad (Bachelors)
College Grad (Masters)
Some High Scgool (no diploma)
Employment Status
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Employed
Self-Employed, Freelance, Entrepreneur
Unemployed
Student
Military
Last 5 years of employment/school history
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Describe your skills:
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How do you want to build on your skills through this training workshop:
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Skills and qualifications desired:
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PHOTO ID
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Proof of State residency (e.g. : utility bill, medicaid card, bank statement, etc)
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LinkedIn URL
Portfolio URL
Ethnic Background
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Afro American
Afro- Carribean
Asian/Asian - American
Caucasian (white)
Hispanic/LatinX
Bi-Racial/mixed
American Indian (indigenous)
other
Language(s) spoken
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English
Spanish
Haitian Kreyol
Swahili
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other
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