CE Application

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Application

This application is to be used to register for Journeyman Continuing Education Classes only.

Important Note: In order to prevent your confirmation letter, with your login info and passwords, from going to your spam folder, please add my email address (mike@cctc.edu) to your contacts immediately after completing this application.  If you do not receive your login info within 8 working hours, please check your spam folder.  It is more than likely there.
 

Please provide the following contact information
(Bold items are required fields):

Last Name:  
First Name:  
Middle Initial:   If no middle initial use NA!
Date of Birth:  
(e.g. xx/xx/xxxx)
SSN (Last 4 Digits):  
(e.g. xxxx)
Street Address:  
Address (cont.):  
City:  
State:  
Zip Code:  
Country:  
Cell Phone:  
(e.g. xxx-xxx-xxxx)
Home Phone:  
(e.g. xxx-xxx-xxxx)
E-mail:  
CE Option:  
CE Option E Only!  
Referred by:  

If you were referred by one of our current or former students, please let us know who that person is by giving us his name, address, and telephone number.  He will receive a $20.00 credit (for a 32 hour course referral) or a $5.00 credit (for 8 hour course referral) towards his next course.  If you were referred by your employer, please give us the company information.
Referral Information:  

If you have questions or have not received a confirmation of your registration, please call 510-785-2282 or 800-678-6669.

Note: In order to receive a completion confirmation letter (required by the State of California for registered electrical trainees), CCTC must receive full payment for all classes.

If you would like to download a mail-in application, please click here.  This form can be filled in using Adobe Acrobat Reader or with a pen or pencil. Then it can either be mailed to the address on the form or faxed to 510-785-9136.

Files in Adobe Acrobat PDF format are viewed with Adobe Acrobat Reader. If you do not already have Adobe Acrobat installed on your computer, you should download the free Acrobat Reader from Adobe's web site at www.adobe.com, download instructions are available on the Adobe web site. Once you have downloaded the Acrobat Reader you can view PDF documents in your web browser if it supports plug-ins or, if it does not support plug-ins, you can save the file(s) to your hard drive and view them by opening them in Acrobat Reader.

 

 

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Last modified: 01/11/12