Partner Program Registration Form
Please complete the form shown below and submit to register and obtain a user account at our web site. Please read our Privacy Policy to know how we use the information that you provide us through this form.
All fields marked with
*
are mandatory
School/Institute Information
School / Institution Name
*
Address
*
Street
City
*
State
*
AL
AD
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code
*
Phone
*
(
)
-
Contact Person Information
First Name
*
Middle Name
Last Name
*
Prefix
Mr.
Ms.
Job Title
Phone
*
(
)
-
Email
*
Please make sure you provide a valid and functioning address, as your password (required for you to successfully login) and PIN will be sent to this email address.
School/Institute Detail
How long has the institution been functioning?
Number of Instructors
What courses do you offer?
Method of instruction
Classroom
Self Study
Both
Average number of enrolments / year
Do you have a web site for your Institution?
Yes
No
Your website address (URL)
Site user Information
Prefered User Name
*
(
min 6 characters)
Hint Question
*
The Hint Question and Answer will be used to verify your identity, when you request lost password retreival
[Select One]
What is the name of your first school?
What is your favourite pass-time?
What is your mother's maiden name?
What is your favourite food?
What is your exact time of birth?
Hint Answer
*
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