Student Registration Form

Please provide the following information:

*First Name:
*Last Name:
*Home Telephone:
Pager/Beeper:
Cell Phone:
Cell Phone Provider:
If other Cell phone provider please enter here
Does your cell receive text messages?
Name of Company you work for:
What is your company's web site?
What Department do you work in?
What is your position there?
Office Telephone 1:	ext.
Office Telephone 2:	ext.
Fax Office:
Please Enter in Order of Preference::
*E-mail:
*E-mail 2:
*E-mail 3:(if you do not have a 3rd a/c repeat the first one please
Do you have a website?
If yes, what is your web address?

Where do you know me from /what course have you taken with me/ or will be taking with me?
If other please explain
When did you take the course or when did we meet?
Are you an undergraduate currently?
If Yes, What is your major?
If No, What was your major?
Are you a Graduate currently ?
If Yes What program are you with?
If other please explain
Tell me a little about your IT knowledge:
*Excel:
*Word:
*Power Point:
*Access:
*Word Perfect:
*Visio:
MCSE:
MCSD:
A+:
Java:
Fiber Optics:
Any other software that you are comfortable with?
Tell me a little about yourself if you would like