M A R I S T Institute for Data Center Professionals

Enrollment Form

Exact Legal Name: Last / Family/Sur: First/ Given: Middle:

Permanent Address:

City: State: Zip: Country

E-mail:

Day Phone: Eve Phone: Cell Number:

U.S. Social Security #:

Citizenship: U.S. Citizen Dual U.S. Citizen U.S. Permanent Resident

List any Non-U.S. Countries of Citizenship:

The above listed participant enters into an agreement with MaristCollege under which the school will instruct the participant in the training program course of study listed below.

Course Enrollment Information:
Course Title:
Course Code: Credits:
Session / Start Date:
Course Title:
Course Code: Credits:
Session / Start Date:
Course Title:
Course Code: Credits:
Session / Start Date:
Course Title:
Course Code: Credits:
Session / Start Date: / TUITION & FEES* For completion by Marist College Only
Tuition ($333 per credit) $ ______
AFCOM (15% Discount)
Membership ID: ______
*Not to be combined with other discounts provided by IDCP
SUBTOTAL: $______
Paid upon enrollment: $ ______
Total due before first class: $______

ACKNOWLEDGMENTS

I agree to the conditions of this agreement. I also verify that I have read and received a copy of this agreement. This agreement shall be effective when signed by both the participant and the school’s representative.

I Accept I Do Not Accept Date:

PAYMENT: Checks should be mailed to the address listed at the bottom of this form. If you wish to pay by credit card, please contact (845) 575-3128 or email . You will be directed to the MaristCollege secure payment website.
Students not paying by credit card or check must complete and submit a Marist College Tuition Deferment form. / Instructions: Mail, e-mail or fax the enrollment form to:
The Institute for Data Center Professionals Marist College
Hancock Center, 2nd floor, 3399 North Road
Poughkeepsie, New York12601
Tel: 845 575-3128 Fax: 845 575-3095
Email application or questions to:

Fax 845 575-3095 Attention: Director of IDCP
Email application or questions to:

ADMISSION: IDCP is committed to enrolling students who show the ability and desire to successfully complete the course and program. Students are responsible for any prerequisites specified in the Marist course catalog.

PARTICIPATION: Excessive lack of participation can adversely affect a student’s performance and their success in completing certification. It is the student’s responsibility to participate in all scheduled discussion boards and instructor chats. Excessive non-participation may result in a failing grade.

NOTICES: Certificates and transcripts will not be issued by the IDCP untilall academic and financial obligations have been satisfied.

BOOKS: Textbooks are announced prior to the first class. Purchasing books is the responsibility of the student and is not covered by tuition.

Additional information is requested to complete your registration and application. Items with an * are required, all others are optional. Your enrollment will not be finalized until this information is received. All information provided will be considered confidential and will be used for the purpose of assessing admittance to the program. Please mail or fax this form with your enrollment.

Name:

*MaristCollege Affiliation: None Alumni Have /or had a Marist online account Student

*Date of Birth (mm/dd/yyyy) / / *Gender: Male Female

*Highest Educational Level Achieved

OR: Some undergraduate work and number of completed credits

*Degree Majors (list all degrees and school where degree was obtained):

*Computer/Work Programming Experience

*List programming language proficiency:

*List operating systems familiarity:

*Number of years experience in IT:

Current Employer: Current Job Title:

Summary of Job Responsibilities:

How did you hear about us (choose one)?

Other (please specify)

OPTIONAL INFORMATION: Answering or declining to answer any of these questions will in no way affect consideration of your application for admission; however, it would be helpful to Marist for research purposes. MaristCollege does not discriminate in the admission process on the basis of race, color, sex, religion, disability, age, national origin, sexual orientation, marital, or veteran status.

How would you describe yourself? (Check one)

1. Are you Hispanic/Latino? Yes No

2. Regardless of your answer to the prior question, please select one or more of the following ethnicities that best describes you:

American Indian or Alaska Native (including all Original Peoples of the Americas) Are you enrolled? Yes No

If yes, please enter Tribal Enrollment Number:

Asian Black or African American Native Hawaiian or other Pacific Islander White (including Middle Eastern)