Fill this form only to apply for a course. Incomplete applications will not be processed. 

Please provide the following contact information:

Privacy statement: Only authorized employees of Town Computer will  have access to information collected from our customers and visitors and will be used strictly for business purposes.

Tell us about yourself:

First Name
Last Name
Middle Initial
SS #
Title
Organization
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Home Phone
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Have you ever convicted for a crime ?  Yes No 
If your answer is yes, explain
If yes provide a cop

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Enter the starting date of the class you are registering for. For example, Monday Jan. 1, 2010. . .

Please provide the following ordering information:

BILLING
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* By submitting this form you agree to have your card charged the $60 registration fee for the above class.  This registration fee is non-refundable. All students are required to pay a $25 lab fee at the beginning of the course and IT Assistant Level 1 students are required to pay a $125 lab fee that includes the book, tools and the use of the equipment.  You also agree with our class policies.  

Mattapan Technology Learning Center.
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Revised