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Emory Web Certificate Program Application

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There is a $35 non-refundable application fee for each certificate program. This fee is due prior to completing the program. The fee is waived if you register and pay for all the classes in your program at the same time. You have 12 months from the date of your first class to complete all program requirements.

Name
Date

Contact Information

Street 1
Street 2
City
State
Zip
Daytime Phone
Cell Phone
Email Address

Program

How did you first learn about the program?	Search Engine Catalog Referral from friend/family/coworker Employer
Explain briefly how this program will assist in achieving your career goals:

Are you prepared to complete the hours needed for the selected certificate within the next 12 months?

Yes

No

Professional Experience

What is your current job title?
If not currently employed, what was your most recent job title?
Describe your computer experience. Include the software you have used.
Describe your educational background. Include degree(s) and certification(s).
Do you have internet access? Yes No