Daytime Online Distance Education

Registration for Online Distance Education classes must be completed at least one week prior to the Preferred Start Date. Please check your calendar then click yes to select a date. After submitting this form you will receive an email containing more information about completing registration.

Yes *

Preferred Start Date: *

Are you 19 years of age or older?

Date of Birth *

First Name: *

Last Name: *

Street: *

City: *

State: *

Zip: *

Contact Phone Number: *

Can you receive text messages at this phone number?

Yes

Email:
(e-mail confirmation will be sent after you complete sign up)

How did you find out about our program?

Participation in Online Distance Education Classes requires a computer with working webcam. Do you have access to the required technology? *

Yes	No

Participation in Online Distance Education Classes requires internet access. Do you currently have internet access with adequate speed? *

Yes	No

Daytime Online Distance Education

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