On-Line Application

Please fill out your On-Line Application form and click the SUBMIT Button to submit your Application form for consideration.
             
       
* = Required

     *First name 
      *Last name 

            *Sex Male Female

  *Date of birth  MM/DD/YY 
  Place of birth 

   *Home Street Address 
     Apt.#/Suite 
           *City 
 *State/Province 
*Zip/Postal code 
        *Country 

     *Home Phone 
             FAX 
         *E-mail 

   Do you have access to a Computer? 
		      Yes No

   Do you have internet access?		
	At Work?      Yes No	

	At Home?      Yes No

    Employment History - Last Three Years Only:

  Occupation/Job Title 
   Years of Experience 
              Employer 

  Occupation/Job Title 
   Years of Experience 
              Employer 

Educational Background:      

	   High School 
	          City 
  	         State 
 	       Country 

    College/University 
	          City 
  	         State 
 	       Country 
		Degree NoneAssociate's DegreeBachelor's DegreeMaster's DegreeDoctorate Degree
 	  	 Major  None 
     Number of Credits SemesterQtr.
   

        Other Training:

  Title or Description
            of Program 
              Location 
                  From  To 
                 Major 
                       Certificate  
		       Diploma 
           Total Clock Hours 

  Title or Description
            of Program 
              Location 
                  From  To 
                 Major 
                       Certificate  
		       Diploma 
           Total Clock Hours   

Please Check One of the following Certification Programs: 

 Certification in Business Management 
 Certification in Financial Accounting 
 Certification in Human Resources Management
 Certification in Marketing Management
 Certification in Healthcare Administration
 Certification in Logistics & Supply Chain Management
 Certification in Customer Relations Management 
 

Tuition and Fees Payment Options:

Tuition		$900

Enrollment fee	$100

Certificate Charges	$100

Total Charges             $1,100

Option A: Payment in full (deduct $50, Net Payment) $1,050. International students should select this option.       

Option B: Pay-as-you-go. $550 to begin the program and $550 before graduation.

  Enter your promotional code, if any 

Applicant's Name: 
        Date:  MM/DD/YY