Computer Literacy Registration Form Contact Information Question Title * 1. Please provide your contact information (Por favor proporcione su información de contacto) First Name (Nombre): * Last Name (Apellido): Address (Dirrecion): * Address 2: City/Town (Ciudad): * State (Estado): * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP (Area Postal): * Email Address (Correo Electronico): * Phone Number (Numero Telefonico): * Question Title * 2. Emergency Contact Emergency Contact Name (nombre del contacto de emergencia) Emergency Contact Number (numero del contacto de emergencia) Emergency Contact Relationship (relaccion al contacto de emergencia) Question Title * 3. Which of the following best describes the principal industry of your organization? (¿Cuál de las siguientes opciones describe mejor la industria principal de su organización o trabajo?) Advertising & Marketing Agriculture Airlines & Aerospace (including Defense) Automotive Business Support & Logistics Construction, Machinery, and Homes Education Entertainment & Leisure Finance & Financial Services Food & Beverages Government Healthcare & Pharmaceuticals Insurance Manufacturing Nonprofit Retail & Consumer Durables Real Estate Telecommunications, Technology, Internet & Electronics Utilities, Energy, and Extraction I am currenlty not employed Question Title * 4. Are you currently employed? (¿Está trabajando actualmente?) Yes (Si) No Question Title * 5. Name of current or previous employment. (Nombre del empleo actual o anterior) Question Title * 6. Time employed at current/previous job (Tiempo empleado en el trabajo actual / anterior): Less than 1 year 1 to 2 years 2 to 3 years 3 to 4 years 4 to 5 years 5+ years Question Title * 7. How many employees were/are at your company? (¿Cuántos empleados había / hay en su empresa?) Question Title * 8. Are you currently an employee with the City of San Pablo? (¿Actualmente es un empleado de la ciudad de San Pablo?) Yes (Si) No Question Title * 9. Demographics Gender: Ethnicity: Primary Language: Question Title * 10. Please indicate your age range (Por favor indique su rango de edad) Age Ranges (rango de edad) 18-24 years old 25-34 years old 35-44 years old 45-54 years old 55-64 years old 65+ years old Age Ranges (rango de edad) menu Question Title * 11. What is the highest level of education you have completed? (¿Cuál es el nivel más alto de educación que ha completado?) Did not graduate High School High School Diploma, GED, or equivalent Some College Vocational or professional certification Associates Degree Bachelors Degree Masters Degree Phd Question Title * 12. What is your approximate average household income? (¿Cuál es su ingreso familiar promedio aproximado?) $0-$24,999 $25,000-$49,999 $50,000-$74,999 $75,000-$99,999 $100,000-$124,999 $125,000-$149,999 $150,000-$174,999 $175,000-$199,999 $200,000 and up Question Title * 13. Pricing per course:San Pablo Residents.........................................................$20San Pablo Residents enrolling in all three courses............$40 totalNon-San Pablo Resident....................................................$50Non-San Pablo Resident enrolling in all three courses.......$100 totalSPEDC Member.................................................................$30San Pablo Business Owner................................................$40Non-San Pablo Resident....................................................$50Cancellation Policy: Payment will be collected first day of class. Registration fees are refundable ONE WEEK BEFORE CLASSES START. Cancellations after deadline will receive a credit towards next registration.**Proof of residency will be required**Residentes de San Pablo ..................................................... $ 20Residentes de San Pablo inscribiéndose en los tres cursos ......... $ 40 en totalNo residente de San Pablo .................................................. $ 50No residente de San Pablo inscrito en los tres cursos ........ $ 100 en totalMiembro de SPEDC ............................................................. $ 30Dueño de negocio de San Pablo ............................................... $ 40Residente no de San Pablo .................................................. $ 50Política de cancelación: El pago se cobrará el primer día de clase. Las tarifas de inscripción son reembolsables UNA SEMANA ANTES DE QUE COMIENCE LAS CLASES. Las cancelaciones después de la fecha límite recibirán un crédito para la próxima inscripción. Question Title * 14. Please indicate your registration eligibility (Por favor, indique su elegibilidad de registro): San Pablo Resident SPEDC Member San Pablo Business Owner Non-San Pablo Resident Question Title * 15. Register to the following courses, check all that applyRegístrese en los siguientes cursos, marque todos los que correspondan: Windows 8 & Exploring the Internet Intermediate Quickbooks 2015 Microsoft Office Suites All three Question Title * 16. How did you hear about these classes?¿Cómo se enteró de estas clases? Done