Registration Form
Name
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First Name
Last Name
Home Phone
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Area Code
Phone Number
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Number
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Area Code
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Student Email Address
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example@example.com
Current Grade Level
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Freshman
Sophomore
Junior
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Birthdate
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School Name
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District Name
Parent Information
Parent Name
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First Name
Last Name
Home Phone
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-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone
*
-
Area Code
Phone Number
Parent Email
*
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Fall 2019 Course Name
ACT National Career Readiness Prep
Business I (online)
Business Regulations and Ethics (online)
Career Success Skills (online)
CompTIA A+ Certification Prep
CompTIA Network+ Certification Prep
Customer Service (online)
Digital Literacy Certification Prep
Microsoft PowerPoint Certification Prep
Microsoft Word Certification Prep
Word-Processing I (online)
Principles of Information Technology
School Approval
*
School approval is required for registration in these courses. In the box above provide the name and contact information of the person at your school who will grant approval for this course. Please include full name, telephone number, school, and email address.
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