Mobile Computer Classes

Mobile Computer Class Proposal Form

To request a time slot for our computer classes at your facility please fill out the information below and a C3 representative will contact you shortly.

Today's Date (MM/DD/YYYY):*      

First & Last Name:*   Title/Position:*
Phone Number:*   Email Address:*
Name of Location:*   Type of Location:*
     
If Other:

Address:*   Facility Phone Number:*
C3 Representative Name:      
(If none write n/a)        

Please select at least one class that you would like to request for your facility.

Class 1:*      

Proposed Day(s):   Date(s):
Time(s)   Registration Deadline:
Length of Class:   Program Cost:

per student

Class 2:      

Proposed Day(s):   Date(s):
Time(s)   Registration Deadline:
Length of Class:   Program Cost:

per student

Class 3:      

Proposed Day(s):   Date(s):
Time(s)   Registration Deadline:
Length of Class:   Program Cost:

per student

Class 4:      

Proposed Day(s):   Date(s):
Time(s)   Registration Deadline:
Length of Class:   Program Cost:

per student

Notes: