Floor Covering
Registration Form
Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
What is Your Preferred Method of Contact?
*
Phone Call
Email
Text
DOB
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
SSN (Last 4 digits)
*
High School Graduation Status
Did Not Graduate
Obtained GED or Similar Certificate
Currently Enrolled in High School
Graduated (Please Specify Year)
Year of Graduation from High School
Which Course are you Interested in?
*
Floor Covering Installer (8 Week Program)
Floor Covering Sales & Service (2 Week Program)
Floor Covering Installer – Upskill (2 Week Program)
How will you Finance this Course?
*
Self
Partner such as Michigan Works
Submit
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