Registration Form

Certified Nanotech and Clean Tech Professional (CNCP)
May 19 - June 27, 2008 in San Jose

* = Required fields.

(Please note that this Registration Form is best used with the Internet Explore Web Browser)

   
*Prefix:  Prof. Dr.  Mr. Mrs. Ms. Miss
*First Name:   M.I.
*Last Name:  
 Title:  
Organization (optional)  
*Street Address:  
*City:  
 State:  

 Province:

*Country:  
*ZIP/Postal Code:  
*Phone:  
 Fax:  
*E-Mail:  
*This address is  
Invited Guest of (if applicable)
Your qualification and working experience
* Your highest degree of formal education Bachelor      Master     MBA   PhD    Other, give below
   
*Industry
* Years of working experience 1-5 years    6-10 years    11-15 years 16-20 years 
21-25 years 26-30 years   31-35  years more than 35 years
   
*Work Status Employed    Self-employed    Unemployed
   
Name of your previous employer
   
*Tenure at your current or (if unemployed) last employer      years months
   
*If unemployed, for how long? (check one) 0-3 months       3-6 months      6-12 months    
12-18 months    18-24 months  More than 2 years   
   
Veteran Status No       Yes, > 180 days      Yes, < 180 Days   
   
Do you have an Employment Training Account (ETA)? Yes     No
   
Have you received any assistance under the EDD or WIA Training Program
None
 Trade Adjustment Act (TAA)
 Veteran's DVOP/LVR
Veteran's EDD
Other, non-WIA Program (specify below)    
   
Citizenship U.S. Citizen       Permanent Resident       Other (specify below)

  
                                                                                  
   
* What do you wish to accomplish as a result of this training program  
   
* How did you hear about us? Email
 Newspaper
 Craigslist
 Your web site
 Referral from Workforce Investment Board  
 Radio
 Search Engine
 Job Fair
 Personal referral
Other
   

Terms and Conditions    
By registering in the above training program, the participant hereby abides to the terms and conditions of California Institute of Nanotechnology ("CINANO")

REQUIREMENTS:

1. Candidates must have a Bachelor of Art (BA), or Bachelor of Science or Engineering or equivalence
2. Candidates must have at least three years of working experience.
3. Candidates must successfully complete an assessment test
4. A non-refundable deposit of $395 is required upon confirmation of enrolment
5. Financial aid is available for qualified candidates.

Please note: Submission of this form does not denote enrolment in the program. Qualified candidates will be contacted to complete the assessment test and schedule an interview at our San Jose location. 
Declaration    
  CHECK HERE to signify that you have read and understood the conditions of registration and cancellation policy.

   

 

© 2006-2008
 California Institute of Nanotechnology, Inc.
1290 Parkmoor Avenue, San Jose, CA 95126 USA
Tel. 408-280-6266  Fax. 408-280-6255
Email: info@cinano.com
http://www.cinano.com