Contact Request Form
Thank you for taking the time to complete our Contact Request Form. The data provided will be used by our counselors to provide you the most accurate information possible.
*
1.
Student First Name
(Required.)
*
2.
Student Last Name
(Required.)
*
3.
Phone Number
(Required.)
4.
Email Address
*
5.
Which program(s) are you interested in? Select all that apply:
(Required.)
HSE (GED,HiSet)
ESL
Citizenship
IET (CMA, EKG, Billing & Coding, Entrepreneurship, etc...)
*
6.
Are you new or returning student?
(Required.)
New Student
Returning Student (Enrolled within the last 24 months)
*
7.
Do you prefer morning or evening classes?
(Required.)
Morning
Evening
Undecided
Already Attending Classes
8.
What technology do you have access to? (Select all that apply.)
Wifi
Desktop Computer
Laptop
Tablet (iPad, kindle, etc.)
Smart Phone
Web Cam
*
9.
How did you hear about our program? Select all that apply:
(Required.)
Facebook / Social Media
TV / Radio
Friend or Family Member
School District
Temple College Website
Workforce
Other (please specify)
