Enrollment Request for Individuals

Please complete this questionnaire so that we better understand your learning expectations.
* Required Fields

First Name: *
Last Name: *
Street Address: *
City: *
State: Pennsylvania
Zip: *
Email: * (If none, enter no@email.com)
How can I get an Email Address?
Phone: *
Referring Agency: (If applicable)
Agency Contact:
If currently employed what type of job do you have?
If currently employed, is your employer paying for your ICDL training?
If yes, what is the name of your company?
If currently unemployed what type of job are you seeking?
Does this position require computer skills?
If yes, what type of skills are required? Word processing (Word, WordPerfect, Corel)
Database (Access)
Spreadsheets (Excel)
Presentations (PowerPoint)
Internet / E-mail
Other

If other please describe:

What is your highest level of education completed?*
How often do you use a computer?*
Have you ever taken a computer class?*
If yes, please identify the type of class taken. Word processing (Word, WordPerfect, Corel)
Database (Access)
Spreadsheets (Excel)
Presentations (PowerPoint)
Internet / E-mail
Other

If other please describe:

Do you hold any computer certifications?*

If yes, please list certifications:

Please rate your computer skills by using the following ranking: *
(1) No Knowledge (2) Some Knowledge (3) Good Skills (4) Expert
Basic computer concepts: 1   2   3   4
Using the computer to manage files: 1   2   3   4
Word processing: 1   2   3   4
Spreadsheets: 1   2   3   4
Databases: 1   2   3   4
Presentations: 1   2   3   4
Internet and E-mail: 1   2   3   4
Please select the Training and Testing Center most convenient for you: *

Lock Haven, Clinton County
Mill Hall, Clinton County
Coudersport, Potter County
Galeton, Potter County
Philadelphia
Port Allegany, Potter County
If you are selected for ICDL Training, what method of instruction would you prefer?* Internet-based / Online
CD (Compact Disc)
Instructor-led
 
If Instructor led please select time most convienient.
How did you learn about the ProjectTIME/ICDL Certification program?

If Other:

Your age? (Optional)
 
Gender / Race-Ethnicity: (Optional)

 

By submitting this Request for Enrollment, I understand that if I am selected for this project, I must be willing to report testing, training, job search, and employment information to a Training and Testing Center coordinator. I understand that completion of this questionnaire does not guarantee or entitle me to any services, training or testing associated with this program. I understand that if I am selected for this project that I must enroll and take a pre-test. I understand that I will be notified within 30 business days if I am selected for this project.

Please hit the "Submit Request" button ONLY ONCE.

  

2986 N. Second Street, Harrisburg, PA 17110 | 1-877-753-9658 | Fax 717-720-7082