SQAtester.com - Pre-Registration Form

Pre-Registration Form
(Print Form)
(Print and fill in form) - Fax number: 423-3580

Have you taken any classes from SCAE (Santa Clara Adult Education) since the fall of 1998? If yes fill in social security or SCAE Student ID # and name only! If no, please fill in the complete form.

PLEASE COMPLETE FORM BEFORE REGISTERING

Social Security or SCAE Student ID #:

Name:

Address:

City:

State:

Zip:
Home Phone:

Work Phone:

Ethnicity:

Native Language:
Sex: Male
Female

Method of Payment

Master Card Gift Certificate

VISA

Check #

Card #

Exp. Date:

Signature: ______________________

Class Name
Days

Time

Reg./Lab Fees

Do not write below this line - Office Use Only !

Student Type:
Reg Adult HS Diploma Concurrent CalWorks

Home School:

Pre-Registration Form (Print Form) (Print and fill in form) - Fax number: 423-3580
Have you taken any classes from SCAE (Santa Clara Adult Education) since the fall of 1998? If yes fill in social security or SCAE Student ID # and name only! If no, please fill in the complete form. PLEASE COMPLETE FORM BEFORE REGISTERING
Social Security or SCAE Student ID #:
Name:
Address:
City: State: Zip:				Home Phone: Work Phone:
Ethnicity: Native Language:			Sex: Male Female
Method of Payment
Master Card	Gift Certificate
VISA
Check #
Card # Exp. Date:
Signature: ______________________
Class Name		Days			Time	Reg./Lab Fees