Certificate Program Application

Students who wish to pursue a certificate program are required to fill out the application below. Call 703-683-7453 with any questions about the certificate application process.

choose program

Specialty Program:
Adobe Photoshop
Business Basics
Editing Specialist
Macromedia Director Series
Macromedia Dreamweaver Series
Multimedia Specialist
Newsletter Creation
Technical Editing
Web Specialist

Master Program:
Administrative Tools
Adobe Creative Suite
Adobe Tools
Desktop Publishing
Dynamic Web Development
E-Commerce
Macromedia Tools
Management Professional
Professional Editing
Publications Management
Publishing Professional
Web Content Professional
Web Design
Web Development

student information
* denotes required information

First Name*
Last Name*
Title
Organization
Address*
City*
State*
Zip*
Work Phone*
Work Fax
Home Phone
Home Fax
E-Mail Address*

payment information

A Check
B Charge my Visa   MasterCard   American Express
Card Holder:
Card Number:
Exp. Date:
(Do you need a credit card receipt faxed to you? YES NO)
C Pre-approved government or corporate purchase order.
      Please send P.O. via fax or mail.
D Bill Company
Billing name:
Date:
Billing address:
Billing address cont:
City:
State:
Zip:

My training will be prepaid (15% discount).
My training will be paid per class.

additional information

Platform Location Start Date
Number Course Title PC MAC ALX SS DC Mo. Day Year Tuition

additional information

Are you currently or have you previously enrolled in EEI training courses?
Yes     No

If yes, please list courses

Your privacy is important to us. EEI Communications does not share your information with third parties, nor do we use it for our mailings without your permission. The information you have provided on this online form is not stored on our Web servers and is protected from outside acquisition. EEI may use your information when rendering services at your request or providing fullfillment services for your order.

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