Personal Information
* Required
* Referral:
How did you learn about us?
Academic Advisor
Community Event
Facebook
Flyer/Brochure
Friend or Family Member
Instagram
Job or Co-Worker
LinkedIn
Newspaper/Magazine
OCPE Website
Online Event Calendar
Other Email
Radio/Television
Twitter
VCU Alumni News
VCU Basketball Game
VCU Digital Signage
VCU Grad Fair
VCU HR
VCU TelegRAM
YouTube
* First Name:
* Last Name:
* Permanent Address:
(You will be asked for your Billing Address prior to payment.)
* City:
* State:
...
Alabama
Alaska
Alberta
Arizona
Arkansas
British Columbia
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Manitoba
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Brunswick
New Hampshire
New Jersey
New Mexico
New York
Newfoundland
North Carolina
North Dakota
Northwest Territories
Nova Scotia
Nunavut
Ohio
Oklahoma
Ontario
Oregon
Pennsylvania
Prince Edward Island
Puerto Rico
Quebec
Rhode Island
Saskatchewan
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Yukon
APO-Europe
APO-Pacific
APO-Cen/South America
International
* Zip/Postal Code:
* Phone:
Employer:
Job Title:
* Birthdate:
/
/
(mm/dd/yyyy)
* Gender:
...
Female
I prefer not to disclose
Male
* Ethnicity:
...
White Non-Hispanic
American Indian/Alaskan Native
Asian or Pacific Islander
Black Non Hispanic
Hispanic
I prefer not to disclose
Other
* Education Level:
...
Associate's Degree
Bachelor's Degree
Doctoral or professional degree
High school diploma or equivalent
I prefer not to disclose
Less than high school
Master's Degree
Postsecondary non-degree award
Some college, no degree
Household Income:
...
$100,000 or more
$25,000 to $34,999
$35,000 to $49,999
$50,000 to $74,999
$75,000 to $99,999
I prefer not to disclose
Less than $25,000
Special Needs:
* Agree to Disclosure of Information:
VCU CPE works with a number of internal and external partners and third parties to deliver some of its events and educational offerings.
By registering, you consent to the disclosure of your name, address, email and phone number to these partners and third parties when applicable. To determine if the course you are registering for falls into one of these types of partnerships, please refer to the bottom of the program specific information page.