TBI Registration Form Student's Name * Required First Middle Last Last 4 Digits of Social Security Number * RequiredDate of Birth - must be mm/dd/yyyy format * Required MM slash DD slash YYYY Telephone * RequiredStudent Email Address * Required Address * Required Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Sex * Required Female Male Other Race * Required American Indian Alaskan Native Asian Black/African American Hispanic/Latino Native Hawaiian/Pacific Islander White Other In case of emergency, notify:Name * Required First Last Phone * RequiredADA: Do you require any special accommodations under the American Disabilities Act? * Required Yes No If yes, explainEducation * Required College Graduate High School Graduate GED High School Student Employer * Required Employer Address * Required Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Course Name * RequiredNoneAdvanced Electrical Systems for Manufacturing Technicians ONLINEAmmonia Operator IAmmonia Operator IIAutoDesk Inventor Level IAutoDesk Inventor Level IIAutomotive Core Tools OverviewBasic Electrical Systems for Manufacturing Technicians ONLINEBasic ElectricityBasic First Aid and CPRBasic Math for Advanced Manufacturing Technicians ONLINEBasic Mechanical Systems for Manufacturing Technicians - OnlineBoiler TechControl Circuit TroubleshootingElectrical Blueprint, Schematic, and Wiring Diagram TrainingElectrical Troubleshooting 1Electrical Troubleshooting 2Excel 2019 Data Analysis with Pivot TablesExcel Part IExcel Part IIFluid Power Systems for Manufacturing Technicians ONLINEForklift Train the TrainerFundamentals of HydraulicsFundamentals of Mechatronics with PLCs & Robotics OnlineIndustrial ElectricityIndustrial Motors and ControlsIndustrial Transformer InstallationIndustry 4.0 Level I - OnlineIndustry 4.0 Level II - OnlineIntermediate Electrical Systems for Manufacturing Technicians ONLINEIntermediate Mechanical Systems for Manufacturing Technicians - OnlineIntermediate PLC Programming - OnlineIntroduction to LeanIntroduction to Lean Manufacturing - OnlineIntroduction to Manufacturing Materials - OnlineIntroduction to PLC Programming - OnlineIntroduction to Robotics & Computer Programming - OnlineISO AuditorMachinery Room DesignMaintenance Awareness-Certified Production Technician-Fast Track ONLINEManufacturing Process & Production-Certified Production Technician-Fast Track ONLINENFPA 70EOSHA 10OSHA 30PLC Level 1PLC Level 2PowerPoint Part 1PowerPoint Part 2PSM/RMP ProgramPump Systems and Motor TrainingQuality Assurance Technician - ONLINEQuality Practices & Measurement-Certified Production Technician-Fast Track ONLINERAGAGEP, Ammonia Operator IIIRoot Cause Analysis/Problem SolvingSafety-Certified Production Technician-Fast Track ONLINESpanish Ammonia Operator IValue Stream MappingVariable Frequency Drive Training5SWelding for Industrial MaintenanceWord 2019 - Part 1Word 2019 - Part 2Word 2019-Part 3Date Beginning - must be mm/dd/yyyy format * Required MM slash DD slash YYYY Course Name * RequiredNoneAdvanced Electrical Systems for Manufacturing Technicians ONLINEAmmonia Operator IAmmonia Operator IIAutoDesk Inventor Level IAutoDesk Inventor Level IIAutomotive Core Tools OverviewBasic Electrical Systems for Manufacturing Technicians ONLINEBasic ElectricityBasic First Aid and CPRBasic Math for Advanced Manufacturing Technicians ONLINEBasic Mechanical Systems for Manufacturing Technicians - OnlineControl Circuit TroubleshootingElectrical Blueprint, Schematic, and Wiring Diagram TrainingElectrical Troubleshooting 1Electrical Troubleshooting 2Excel 2019 Data Analysis with Pivot TablesExcel Part IExcel Part IIFluid Power Systems for Manufacturing Technicians ONLINEForklift Train the TrainerFundamentals of HydraulicsFundamentals of Mechatronics with PLCs & Robotics OnlineIndustrial ElectricityIndustrial Motors and ControlsIndustrial Transformer InstallationIndustry 4.0 Level I - OnlineIndustry 4.0 Level II - OnlineIntermediate Electrical Systems for Manufacturing Technicians ONLINEIntermediate Mechanical Systems for Manufacturing Technicians - OnlineIntermediate PLC Programming - OnlineIntroduction to LeanIntroduction to Lean Manufacturing - OnlineIntroduction to Manufacturing Materials - OnlineIntroduction to PLC Programming - OnlineIntroduction to Robotics & Computer Programming - OnlineISO AuditorMachinery Room DesignMaintenance Awareness-Certified Production Technician-Fast Track ONLINEManufacturing Process & Production Technician-Fast Track ONLINENFPA 70EOSHA 10OSHA 30PLC Level 1PLC Level 2PowerPoint Part 1PowerPoint Part 2PSM/RMP ProgramPump Systems and Motor TrainingQuality Assurance Technician - ONLINEQuality Practices & Measurement-Certified Production-Fast Track ONLINERAGAGEP, Ammonia Operator IIIRoot Cause Analysis/Problem SolvingSafety-Certified Production-Fast Track ONLINESpanish Ammonia Operator IValue Stream MappingVariable Frequency Drive Training5SWelding for Industrial MaintenanceWord 2019 - Part 1Word 2019 - Part 2Word 2019 - Part 3Date Beginning - must be mm/dd/yyyy format * Required MM slash DD slash YYYY Purchase order number or pre-payment required. Complete withdrawal prior to course deadline, full refund will be given. No refunds after course deadline, however substitutes are allowable. Failure to attend the program does not constitute withdrawal.Payment Method * RequiredCredit Card (American Express excluded)CheckBy signing this form I acknowledge that I have read and understood the payment and refund policy. * Required I agree.Student Name * Required First Last Date - must be mm/dd/yyyy format * Required MM slash DD slash YYYY Contact Person * Required First Last Email for contact person * Required Phone number for contact person * RequiredEmail for accounts payable * Required Phone number for accounts payable * RequiredIn the event Snead State should experience the need for all in-person classes to transition to remote instruction due to the COVID-19 pandemic or other event warranting the need for such plans, such communication will be provided to the students. This communication will provide details to the program’s remote instructional plan to complete the necessary theory, lab and/or clinical to meet the course objectives necessary for successful completion in a remote environment. For further information contact Teresa Walker or Cherri Barnard.CAPTCHA
