Tech24 University Enrollment

Enrollment Form

** The E-mail you provide is used to send the student their test results during and after classes. The cell phone is just in case we need to contact the student before or during class weeks. We will not use this for any other purpose.**

Student Info:

First Name (required)

Last Name (required)

Email Address (required)

Contact Number (required)

Emergency Contact

Emergency Contact Relation

Emergency Contact Number

Company & Representative Info:

(for reporting purposes only)
Representative's Name(required)

Company Name (required)

Street (required)

City (required)

State (required)

Zip Code (required)

Company Phone Number (required)

Supervisor's Name (required)

Supervisor's Email Address (required)

Supervisor's Contact Number (required)

Classes:

**You may enroll in up to 4 classes per form**

Please put the MONTH of the class in the notes section below

First Class

Second Class

Third Class

Fourth Class

Notes (required)
(we need the month of the classes you are requesting at a minimum)