Name *

First Name

Last Name

Date *

MM

DD

YYYY

Mobile phone number *

(###)

###

####

Preferred phone number, if different

(###)

###

####

To participate, you must confirm that you: *

1) Have good access to a computer to view the course and it is capable of streaming video.

Yes

No

Confirm that you: *

2) Are able to enroll between May 22nd and June 5th (30 minute phone call).

Yes

No

Confirm that you: *

3) Will attend all 3 mandatory sessions (sessions 1-3 are 6-8 hour sessions). 1st Session: 9 a.m. - 5 p.m. Sun., June 26th 2nd Session: 9 a.m. - 5 p.m. Sun., July 17th 3rd Session: 9 a.m. - 5 p.m. Sun., Aug 7th

Yes

No

Confirm that you: *

4) Will abide by a completion date before July 19th. A date for the exams needs to be scheduled by the attendee between 9 a.m. - 5 p.m. on weekdays. It should ensure uninterrupted time for each of two 2-hour exams. The dates chosen must be given to the course coordinator BEFORE the 3rd live session.

Yes

No