Student Self-Registration Form

ATTENTION!

Registration in our system does not guarantee a space in the group!
To reserve a spot, please make your first payment!

Student Information:

*Student's Full Name:

*Gender:

*Visa Status:

*How do you plan to attend?

Contact Information:

*Street Address:

Street Address Two:

*City:

* State:

*Zip Code

*Cell Phone Number:

Home Phone Number:

*Email:

Personal Information:

*Date of Birth:

*ID number (e.g.: Driver's License):

Emergency Contact:

*Full Name:

Relationship to You:

Full Address:

*Phone Number:

Program Information:

*Interested Program:

*Expected Enrollment Date:

The School Rules, Procedures, and Policies:

*The Portnov Computer School catalog - online Click Here to Open

*Cancellation/Withdrawal policies Click Here to Open

*The Refund policy and the examples of calculating a refund Click Here to Open

*Rules of Operation Click Here to Open

*School Performance Fact Sheet Click Here to Open

*Non-Discrimination Policy Click Here to Open

(In order to continue, you should READ ALL the Rules, Procedures, and Policies above.)

* I read all the School Rules, Procedures, and Policies.

*How did you find out about the Portnov Computer School?

*How would you evaluate your English knowledge?

from 1-beginner to 10-native

*What is your education level and major (field of study)?

*Do you have any experience in IT industry, and if yes, what technologies are you familiar with?

*I have read and understood all the disclosures on this page.

*Student Full Name:

Date: Fri, April 19, 2024