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Forms
Online Course Enrollment Form
Online Course Enrollment Form
A form to enroll students in an online course by collecting necessary details.
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Code
First Name
*
Last Name
*
Email Address
*
Phone Number
Date of Birth
*
Highest Education Level
*
High School
Associate's Degree
Bachelor's Degree
Master's Degree
Doctorate
Other
Course Selection
*
Introduction to Programming
Web Development Fundamentals
Data Science Essentials
Digital Marketing Basics
Graphic Design Principles
Preferred Start Date
*
March 1, 2025
April 15, 2025
June 1, 2025
September 1, 2025
Preferred Course Format
*
Self-paced
Live Online Classes
Hybrid (Self-paced with Weekly Live Sessions)
Learning Goals
*
How did you hear about us?
Search Engine
Social Media
Friend/Referral
Advertisement
Email
Payment Method
*
Credit Card
PayPal
Bank Transfer
Payment Plan
I require special accommodations
Accommodation Details
I agree to the terms and conditions of enrollment
Submit