BDPA Triangle SITES Registration 2019
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First Name, Last Name *
Address, City, State, Zip Code *
Phone Number *
Email address *
Parent Name(s), Phone Number, Email address. *
Emergency Contact: Name, Phone Number, Relationship *
School Name *
School Guidance Counselor Name
School Computer Instructor Name
Grade Level *
Expected Year of Graduation *
Enter your GPA *
Ethnicity/national origin? (Some organizations that provide scholarship may ask.) *
How familiar are you with using technology? *
Rate your ability - Select a box below
How familiar are you with building websites? *
Rate your ability - Select a box below
Have you ever taken a computer technology course or training?: *
Select a box below - Yes or No
Required
Computer Experience - Please list any computer courses you have taken: *
What computer languages, operating systems, tools, or applications are you familiar with using? *
Select all that apply from list below.
Required
Are you interested in Mobile Application Development *
Select a box below - Yes or No
Required
College major - planned? *
Extra curricular activities, hobbies, or volunteer work. *
Registration Date *
Are you requesting Financial assistance? *
Number of years in BDPA Student Information Technology program? *
Submit
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