Please review the application before submitting to make sure you have completed all sections. Incomplete applications will not be accepted.

Question Title

* 1. Today's Date

Date

Question Title

* 2. Program Start Date:

Question Title

* 3. First name:

Question Title

* 4. Middle Initial:

Question Title

* 5. Last Name:

Question Title

* 6. Other Names (Maiden):

Question Title

* 7. Date of Birth: (Month/Date/Year)

Question Title

* 8. Street Address:

Question Title

* 9. Apartment Number:

Question Title

* 10. City:

Question Title

* 11. State:

Question Title

* 12. Zip:

Question Title

* 13. Cell Phone:

Question Title

* 14. Other Phone:  (If no other phone, write N/A)

Question Title

* 15. E-Mail:

Question Title

* 16. Confirm E-mail:

Question Title

* 17. Where did you earn your high school diploma?

Question Title

* 18. Please review your responses prior to clicking the submit button. Incomplete forms will not be processed.

Under penalty of perjury, I herewith affirm that my electronic signature, and all future electronic signatures, were signed by myself with full knowledge and consent and are the legally binding equivalent to my handwritten signature.

Electronic Signature (first and last name)

Question Title

* 19. Date: (Month/Date/Year)

We reserve the right to reschedule or cancel any course that does not meet our minimum enrollment requirements.  If a course is cancelled or rescheduled, all fees paid are subject to reimbursement or transference, upon presentation of a receipt.
The Columbus Board of Education does not discriminate based upon race, sex, sexual orientation, religion, color, national origin, age, gender identity or expression, ancestry, familial status, military status, disability, genetic information, or any other legally protected category (collectively, "protected classes") in its educational programs, activities, treatment of people and employment practices.

T