Knowledge Systems Institute Training Programs

Application Form

Registering for classes in:

Fall Semester August to December

Spring Semester January to May

Summer Semester May to August

Year: 20_ _

Name: ________________________ ________________________ ______

Last First MI

Social Security: __ __ __ - __ __ - __ __ __ __ Birthday (MM/DD/YYYY): __ __ - __ __ - __ __ __ __

Street Address: _________________________________________________________

City: ____________________ State: ______ Zip: ____________ Country: _________

Home Phone: ________________ Work Phone: ________________ E-mail: ______________________

Employer Name: ___________________________ Address: _________________________________

Select a program below:

I am interested in the SAS Training Program

I am interested in the Bioinformatics Training Program

I am interested in the Oracle DBA Training Program

I am interested in the IT Training Program

I am interested in the Network+ Training Program

I am interested in the Information Security Training Program

I am interested in the Sun Java 2 Training Program

I am interested in other KSI programs and courses

Check all that apply:

I am new to KSI

I am a current or returning KSI student

I am an international student

I am interested in the Stafford Loan Program (domestic students only)

I am taking these courses for credit *

* If you are taking these courses for credit, you must also complete the Student Application Form and submit admissions document.

Payment Information:

Please Contact KSI Admission Office 847-679-3135 for payable amount

You may include a check for application fee payment , or complete the credit card information below and fax it to 847-679-3166

Please make all checks payable to Knowledge Systems Institute. Thank you.

Mastercard Visa Credit card number: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

Exp. Date (mm/yy): __ __ - __ __ Card holder's name (please print): _________________________

Total Charge Amount: ______________ Signature: ___________________________________