Northwest Technical Center
Continuing Education Program - Adult Services
71 South Main Street St. Albans, VT 05478
Select Your Title:
Mr.
Mrs.
Ms.
Full Name:
Organization:
Street Address:
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Primary Phone Number:
Other Phone Number:
E-mail Address:
How May We Contact You?
Phone
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Please Select Your Preferred Method of Contact or Other:
Please Register Me For:
Select "Yes" for your choices that apply
No
Yes
Computer Competency Super Save - $800
No
Yes
Beginning Computer Skills - $250
No
Yes
Beginning/Intermediate Keyboarding - $200
No
Yes
Introduction to Computer Applications A to Z - $400
Method of Payment:
Select "Yes" for your choices that apply
. Types Name where it applies
No
Yes
Check or Money Order Payable to "Northwest Technical Center
" -
Send by Mail
No
Yes
Visa or Mastercard (Do no send numbers)
-
Call us after you submit this form
Yes
No
VSAC Non-Degree Grant (must be submitted before the first class
)
Yes
No
Please Send Me a VSAC Non-Degree Grant Application
Yes
No
Employer -
Type Name Here:
Yes
No
Dept of Labor - Case Manager Name:
Yes
No
Vocational Rehab- Case Manager Name:
Yes
No
Worker's Comp - Case Manager Name:
Let us know anything else we can do to help you: