A-STEP Registration Form Step 1 of 4 25% Contact DetailsPlease indicate the 2025 A-STEP Class you are applying for(Required) Feb 3 – 14, 2025 May 5 – 16, 2025 Aug 4 - 15, 2025 Nov 3 - 14, 2025 Indicate the 2nd choice (cannot be the same date as the 1st choice) February May August November Name(Required) First Last Social Security Number(Required)Date of Birth(Required) MM slash DD slash YYYY Phone(Required)Email(Required) Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Emergency Contact Name(Required)Relationship to applicant(Required)Contact Phone Number(Required)(Required) Mobile Home Applicant Educational InformationHigh School Name(Required)High School Graduation Date(Required) MM slash DD slash YYYY GED Exam Date (if applicable) MM slash DD slash YYYY High School Address(Required) Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Degree(s) Completed(Required)Check all that apply High School GED Certificate Associate's Bachelor's Master's Doctorate OtherList the Name of College/University/Program(Required)Include the City/State, Dates and Attended Degree Earned Accommodations and AccessibilityDo you have any special needs?(Required) Yes No If yes, please specifyCitizenship & English Language Proficiency InformationAre you proficient in English?(Required) Yes No Country of BirthCountry of CitizenshipIf you are not a US Citizen, identify your type of visaEmail a copy of your I 551 (Alien Registration Receipt Card) or I 94 (Arrival/Departure Record) to [email protected].What inspired you to enroll in A-STEP and pursue a career in sleep technology?(Required)Please provide any personal, academic, or professional experience that sparked your interest in this field.What personal qualities or skills do you possess that you believe will make you successful in the field of sleep technology?(Required)What are your expectations of the CSCC A-STEP Program?(Required) Tuition: The introductory course total is $3500, which includes the $500 registration fee, the cost of the 80-hour Introductory Course, additional resources, and the cost of the A-STEP final exam proctored on the last day of the course. Acceptance and Requirements: Tuition must be paid in full at least 8 weeks before the course begins. Students are required to bring their own laptop for any on-line learning and for the final exam. Within 30 days of applying, applicants will receive an email notification of acceptance or denial to the CSCC A-STEP Academy. Students who are accepted are required to return the acceptance letter via email, within 5 business days of the date on the acceptance letter. The $500 registration fee is non-refundable. Upon acceptance, an Acceptance Packet will be emailed to the student. All forms must be signed and returned to the CSCC A-STEP Administrator, along with the remainder of the tuition ($3000), no later than 8 weeks prior to the start of the course.Consent I attest the above information is accurate and truthful. I have fully read and comprehend the documents needed and the deadline dates stated.SignatureDate MM slash DD slash YYYY
