Ready to apply?Fill Out the Form Below [] 1 Step 1Prospective Student ApplicationPlease fill out the following form. By submitting this application you are confirming that the information provided is completely accurate to the best of your knowledge.First NameLast NameBirthdaydate_rangeGenderMaleFemaleEmailemailPhone NumberNumber TypeMobileHomeWorkBest Time to CallGive a few general day and time optionsStreet AddressResidentialCityStateZip CodeAddressShipping (If Different) – Include city, state, and zipEmergency ContactFull nameEmergency Contact Phone Numberyour full nameRelationship to Emergency Contactyour full nameDate of Most Recent Tetanus ShotMonth and YearEducation HistoryHigh School, Post-Secondary, Trade, etc.0 / Recent Work HistoryJob Titles, Company Names, Timeline, etc.0 / Interests/Talents/Hobbies0 / Why are you interested in training at CIOMIT?0 / CIOMIT Course InterestWhich courses do you want to take at CIOMIT?Program Format PreferenceOn Campus: Power CourseOn Campus: Full Program (12 Month)On Campus: Full Program (9 Month)OnlineDesired Start Datedate_rangeCommentsmore details0 / Submit Formkeyboard_arrow_leftPreviousNextkeyboard_arrow_rightFormCraft – WordPress form builder
