AT CERT App 2017: non-VA affiliates
Thank you for your interest in the AT CERT course. Below is the application for the 2017-2018 course. Applications will be accepted in June and July for 2017.

This application is for individuals who do not work for the VA. If you are interested in applying and are a VA employee, please use this form instead: https://goo.gl/forms/orrPDtGy8ZFmRA9O2

The deadline for applying is Monday, July 24th at 11:59pm ET.

Email address *
Alternate Email Address (optional)
If you have an alternate email (e.g. a personal email in addition to your professional email used above), you may enter it here. Some participants have requested we use the alternate email since they have limited access to their professional email.
Your answer
First Name *
Your answer
Last Name *
Your answer
Phone Number *
Phone number will be used if email contact is unsuccessful or if your email changes.
Your answer
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms