First Name: * |
|
Last Name: * |
|
Email Address: * |
|
City: * |
|
State: * |
|
Zip: * |
|
Counselor Name: * |
|
Referred By: * |
|
Would you like to attend an in-person orientation to learn more about the Metrix Learning System?: |
Yes
No
|
|
Would you be interested in accessing Medical, Production/Manufacturing or Prove It courses?: |
Yes
No
|
|
Would you like a counselor to contact you for additional assistance?: * |
Yes
No
|
|
Veteran Status: |
|
Race/Ethnicity: |
|
Disability Status: |
|
Gender: |
|
Date of Birth: * |
|
What program are you most interested in?: |
|
Employment Status: * |
|
Education: * |
|
Preferred Language: |
|
I have read and understand the Metrix Learning System Policies.
|
|
|
(To reduce the amount of spam, please provide the answer to the following question)
|
Is Ice Hot or Cold? |
|
|
|
|
|
NOTE: Check your email (spam folder too) for your assigned username and password.
|