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ENROLLMENT FORM

Student Information:

Name: (required)

Home Address:

City/State:

Zip Code:

Home Phone:

Employer/Company/AT&T/Union/Century Link:

Garage/Office Location:

(We are not allowed to contact you on your AT&T phone or @att.com email address) so please provide your personal cell and email address below.

PERSONAL CELL NUMBER:

PERSONAL EMAIL (required)

Classes you are interested in enrolling (check one or more):

5G Wireless w/ETA CertFiber Optics Installer (FOI) ETA Certification Available an extra cost $100 Student paysFiber Optics Technician (FOT) ETA Certification Available an extra cost $100 Student pays2020 Tech Formatting & Networking2020 Network SecurityEEF (Updated with TKT II Information for AT&T TKTII exam) Electricity and Electronics FundamentalsFCC GROL (Exam fee of $35 if you wish the license we are prohibited from paying per Horizons)HVAC (Introduction to Heating Ventilation and Air Conditioning with Hands on Labs)Microsoft Word/Excel/Power PointCETa (Certified Electronics Technician Associate) ETA Certification exam for $75 extra cost Student pays)

Other class:

Method of Payment for Class Tuition is CWA Union Benefit:
YesNo

Possible evenings for class:
(example Mon/Wed or Tues/Thur or Mon/Tues or Tues/Wed)

By clicking this box and submitting this form, you the Student, agree to the terms and conditions below and are enrolling in the class (s) you have selected above.

Notice to Student: By submitting this Enrollment Form you are signing this Enrollment Form, you are enrolling in the class you selected and representing you are intending to attend the selected class(s) when a class is formed. You may cancel this enrollment with full refund of CWA Union Training Benefit by calling Ameri-Skills and cancelling before start of class. Once class has started, if you drop the class or miss more than two classes you may not receive your “Completion Certificate” for future training benefits for a long period of time.