APPLICANT NAME *

First Name

Last Name

The schedule for the class sessions will be over four weeks beginning DATE TO BE ANNOUNCED on Tuesday and Thursday evenings from 5:30PM – 7:00PM Will you be available to attend during these times? *

YES

NO

APPLICANT PHONE NUMBER *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are you interested or currently enrolled in any post-secondary education?

Yes

No

WHAT INTERESTS YOU? *

TELL US A BIT ABOUT WHAT YOU MAY WANT TO PURSUE AS A CAREER.

INSURANCE

TECH

MANAGEMENT

CUSTOMER SERVICE

HR

ADMINISTRATION

MARKETING

SALES

ACADEMIA

OTHER...