OIC Program Registration Form

OIC DC Program Application

Please fill in the form below.
Program Interest

Must be resident of Washington, DC
Which Program(s) are you interested in? *

A+ Computer Repair Day Class (18-24 Only) A+ Computer Repair Night Class (18 and above) Family to Family Home Health Aide Microsoft Office Specialist Day Class (18-24 Only) Microsoft Office Specialist Night Class (18 and above)
Personal Information
Full Name *

First Name Middle Name Last Name

Address

Cell Phone Number

- Area Code Phone Number
Home Phone Number

- Area Code Phone Number
E-mail
What is your race?

African American Asian Caucasian Hispanic Native American Other option
Education
Check Appropriate Box *

GED HS Diploma Some College College Degree Masters Degree None of the Above
Date Received your Diploma, GED or Degree? *
If you did not receive your High School Diploma, what was the highest grade you completed?
List Degree(s), Certifications or Awards.
Employment
Most Recent Employer
Position Held
Start Date
End Date
Duties & Responsibilities
Reason for Leaving
Comments or Questions?
Should be Empty:

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OIC DC Program Application