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Application

This application is to be used to register for Trainee Hybrid Classes and 5th year classroom classes.
 

Note: Online classes also require physical meetings for the "hands-on" component of these classes.  Students will be notified as to when these class meetings will be offered.

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):  
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:  
Class:   
Level:  
Class Location:   (For classroom and "hands-on" training)
Referred by:  
   

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: 07/30/10