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Application For Admission
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Quality Computer Training, Service & Support
Email: Webmaster@PCProfessor.com
Please Fax to: (BOCA) 561-750-9872 or (WPB) 561-684-0882
BOCA RATON VOICE: 561-750-7879
WEST PALM BEACH VOICE: 561-684-3333

Name: _______________________________________   Date of Birth: _____________________

Address: _____________________________ City, State, Zip: ____________________________

Driver's License #: ______________________ Social Security #: ____________________________

Home Phone: _________________ Work Phone: _______________ Cellular/Bpr: ____________

Present Occupation: ______________________________________________________________

Do you have any conditions which may interfere with your ability to study or to work in the computer industry? Yes ____ No ____      If Yes, please explain:__________________________________

I would like to enroll in the following class(es): _________________________________________

I am additionally interested in the following class(es):

VOCATIONAL CLASSES		CONTINUING EDUCATION
MCSE Certification	Cisco	Excel	Quickbooks
A+ Certification/Repair	MCDBA	Access	Internet
Certified Internet Wbmstr	MCSD	Word	Autocad
Computer Maint. Tech	MCSA	Powerpoint	Desktop Publishing
Other:	MCP	Frontpage	Other:

I heard of PC Professor from:___________________________________________________________________________

I am enclosing a $50 registration fee in order to save a seat in the specified class. This amount will be deducted from my tuition balance when I sign the enrollment contract and is required of all registrations.

Please charge my: o Mastercard o Visa o Discover o AmEx Name on Card: _______________________________

Account Number: _________________________________ Expiration Date: ___________________________________

Applicant's Signature: ____________________________________________________ Date: _____________________

Please fax the completed form to the appropriate campus: (Boca Raton) 561-750-9872 or (WPB) 561-684-0882
If you need assistance, please call and we will be happy to help.