Computer & Electronics Scholarship Registration

To enter the scholarship drawing and register for the event, please answer all the questions below. Be sure to hit submit when you are finished.

Question Title

* 1. First Name

Question Title

* 2. Last Name

Question Title

* 3. Please provide your contact information.

Mailing Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

Question Title

* 4. What is your date of birth? Please enter month, day, year.
Example: 08/13/75

Question Title

* 5. If you are you a high school student, what is your current grade level?

9th

10th

11th

12th

I am not a high school student.

Question Title

* 6. Which programs are you considering? Please select all that apply.

Computer Programming and Development

Digital Media Technology/Graphic Design

Electronics Engineering

Information Technology

Network Management

Project Management

Undecided

Question Title

* 7. How did you hear about the Computer & Electronics Open House? Please check all that apply.

Word of mouth (family member, friend or teacher told me)

Television advertisement

Social Media (Facebook, Instagram, YouTube, Twitter, LinkedIn)

Advertisement on my phone or computer

Flyer or brochure

Newspaper

Radio

Question Title

* 8. Enter today's date.

Date / Time

Date

Question Title

* 1. First Name

Question Title

* 2. Last Name

Question Title

* 3. Please provide your contact information.

Question Title

* 4. What is your date of birth? Please enter month, day, year. Example: 08/13/75

Question Title

* 5. If you are you a high school student, what is your current grade level?

Question Title

* 6. Which programs are you considering? Please select all that apply.

Question Title

* 7. How did you hear about the Computer & Electronics Open House? Please check all that apply.

Question Title

* 8. Enter today's date.

* 4. What is your date of birth? Please enter month, day, year.
Example: 08/13/75