CompTIA A+ Certification Program Application

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CompTIA A+ Certification Program Application

To register, fill out the secure form below and click submit.

* Required Fields

First Name*

Middle Initial

Last Name*

Address*

City*

State*

Zip*

Phone Number*

Email Address

Date of Birth*

Ethnicity

African American
African
Asian/Southeast Asian/Pacific Islander
American Indian/Native American
Caucasian
Chicano/Latino
Multi-Ethnic
Other
Gender
(Which gender do you self-identify as?)
Male
Female
Other
Are you a Veteran of U.S. Armed Forces?
Yes
No

Do you have a disability or health condition that requires accommodations?

(The BCED values diversity and provides equal access for all of our programs and will assist with implementing disability accommodations for participants.)

 Yes
 No
How would you rate your computer skills?
No experience
Beginner
Intermediate
 Advanced

What is your educational background?

GED
HS Diploma
Some College (Non-Degree)
Associate Degree
BA/BS
 Graduate Degree
What is your technical background? Please check all of those that apply.*
(Lack of any of the options does not eliminate your eligibility.)
 Basic Computer Knowledge
 Microsoft Office
 Internet
 Windows
 Mac
 PC
 Computer Troubleshoot/Repair
 Networking
 DOS

What are your professional goals?*

What are your reasons to become involved with this program?*

Agreement/Disclaimer*
(Please check each of the agreements.)
 I will not miss more than 2 unexcused days.
 
 I consent to have my picture or video taken while attending the computer classes to use for promotional and informational purposes through a variety of communication venues.
 
 I understand that Technology Empowerment Center is not responsible for any injuries, damages, penalties, or losses, including legal costs and expenses, incurred by us or any other person caused by the transportation, installation, use of or any other matters relating to the computer.
 
 The statements on this application are true, complete and correct to the best of my knowledge.
Before clicking Submit please print out a copy for your records.