Employer Partnership Discount Form

Student Details & Contact Information

First Name

Last Name

Email Address

Email Confirmation

Phone Number

Birthdate

Address

Address Line 2

City

State

Zip Code

I am a/an

Employee

Spouse/Dependent of employee

If you are not an employee, enter the employee's name

Organization

Anticipated Start Term

Anticipated Academic Level

Anticipated Enrollment Status

Please select one or more class formats that you are interested in so we can better serve your interest and needs:

In-Person, Day Format

In-Person, Evening Format

Online - no specific meeting dates

Synchronous - Online - Virtual meeting dates

Your current or most recent institution attended

Self-Reported GPA (on an unwieghted 4.0 scale)

Graduation Month/Year