M A R I S T Application Form http://idcp.marist.edu ENTERPRISE SYSTEMS EDUCATION

Exact Legal Name: Last / Family/Sur: First/ Given: Middle: Permanent Address: Gender: Male Female City: State: Zip: Country E-mail: Day Phone: Eve Phone: Cell Number: U.S. Social Security #: Date of Birth (mm/ dd / yyyy): Citizenship: U.S. Citizen Dual U.S. Citizen U.S. Permanent Resident List any Non-U.S. Countries of Citizenship: The above listed participant enters into an agreement with Marist College under which the school will instruct the participant in the training program course of study listed below. This is a fully online program and courses are non-credit.

PROGRAM CONFIRMATION : For Completion By Marist College Only FEES: Tuition is due prior to the first class. Director: Angelo Corridori Director of Large System Education SYSTEM Z Associate Certificate (3-course sequence) Tuition cost: $2700 Program ID: Enterprise Systems Education (Certificates include a 3-course sequence, except z/VM which is one course) Special Introductory Rate for IMS* IMS Application Programming Certificate (3-course Programs: Fall and Spring semester sequence Tuition cost: $2400 DB2 Application Programming Certificate (3-course For Course information: http://idcp.marist.edu sequence) Tuition cost: $2700 Assembler Application Programming Certificate (3- Contact us for scheduled dates, tuition, and enrollment course sequence) Tuition cost: $2700 at: [email protected] COBOL Application Programming Certificate (3- course sequence) Tuition cost: $2700 Select Course: One Course Rate for z/VM* SYSTEM Z Associate Certificate Running Linux Systems in a z/VM Virtualized Environment (1-course) Tuition cost: $1200 ASSEMBLER Application Programming Certificate COBOL Application Programming Certificate DB2 Application Programming Certificate BOOKS: In most cases, books will be available IMS Application Programming Certificate online in PDF format or in the form of handouts.

Running Linux Systems in a z/VM Virtualized Environment The COBOL Application Programming Certificate courses require a textbook.

ACKNOWLEDGMENTS I agree to the conditions of this agreement. I also verify that I have read and received a copy of this agreement. This agreement shall be effective when signed by both the participant and the school’s representative.

I Accept I Do Not Accept Student:

Date

Accepted by Institute for Data Center Professionals (IDCP) at Marist College: ______Date

Fax To: The Institute for Data Center Professionals (IDCP) Marist College 3399 North Road Poughkeepsie, New York 12601 Instructions: After completing pages 1-2, please Fax 845 575-3605 or Telephone 845 575-3588 fax or e-mail your application. Attention: Director of IDCP

Email application or questions to: [email protected] M A R I S T Application Form http://idcp.marist.edu ENTERPRISE SYSTEMS EDUCATION

Additional Information is requested to complete your registration and application. Items with an * are required, the others are optional. All information provided will be considered confidential and will be used for the purpose of assessing admittance to the program.

NAME:

*Marist College Affiliation: None Alumni Have /or had a Marist online account Student

*Highest Educational Level Achieved: Degree Completed (choose one): Choose below: Other Some Undergraduate work and number of credits completed: *Degree Majors (list all, associated degree, school where degree was obtained):

*Computer/Work Programming Experience: List programming language proficiency: List operating systems familiarity:

Current Employer: Current Job Title: Number of years Experience in IT: Summary of Job Responsibilities:

How did you hear about us (choose one)? Choose below: Other (please specify)

OPTIONAL INFORMATION: Answering or declining to answer any of these questions will in no way affect consideration of your application for admission; however, it would be helpful to Marist for research purposes. Marist College does not discriminate in the admission process on the basis of race, color, sex, religion, disability, age, national origin, sexual orientation, marital, or veteran status. How would you describe yourself? (Check one)

1. Are you Hispanic/Latino? Yes No 2. Regardless of your answer to the prior question, please select one or more of the following ethnicities that best describes you: American Indian or Alaska Native (including all Original Peoples of the Americas) Are you enrolled? Yes No If yes, please enter Tribal Enrollment Number:

Asian Black or African American Native Hawaiian or other Pacific Islander White (including Middle Eastern)

ADMISSION: IDCP is committed to enrolling participants who show the ability and desire to successfully complete the course and program. You are responsible for assuring that you have met any prerequisites needed for the training.

PARTICIPATION: Lack of participation can adversely affect a participant’s academic performance and their success in passing the courses. Participants are expected to actively participate in the courses and devote time to completing the course activities. Lack of participation does not release a participant from tuition payment obligations.

NOTICES: Certificates or final course grades will not be issued by the IDCP until all monetary obligations have been met. Thank you!