1. Student Name *
   
2. Address (including Post Code)*
   
   
3. Telephone (day)
   
4. Telephone (eve)
   
5. Email Address *
   
6. Course Information
   Code: *
   Title:  *
   Mode:   Distance Credit ($700) Distance Audit ($700) On-campus Credit ($990) On-campus Audit ($600) Summer School ($400)
   NOTE: All courses are not available in all modes. Be sure of your selection.
7. Towards what degree or certificate are you taking this course to earn a credit?
   Other (please specify) MWS MA CSTC PHD
   If taking a course for graduate credit, have an official undergraduate transcript sent to ICS.
8. How did you hear about ICS? Other Friend ICS Professor ICS Recruiter Other Professor Print Advertsing Web Ad Web Search
9. Do you have any questions/comments?
   

Please note: Once we have received your initial registration for a course we will send you a Student Registration Form, which also acts as your invoice.

If you are interested in receiving more information about applying for a program please contact