Application - AUA Extension

bluegooseexchangeNetworking and Communications

Oct 26, 2013 (3 years and 11 months ago)

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American University of Armenia Extension, Room 109

40 Baghramyan Avenue, Yerevan 0019

Office Phone (010) 51 27 06

E
-
mail:
extension@aua.am



http://www.aua.am/extension




A
PPLICATION FOR
R
EGISTRATION








Network Fundamentals



Routing Protocols and Concepts



LAN Switching and Wireless



Accessing the WAN


Have you attended
AUA Extension
courses?





Yes


No















Name in English:

______________________________________ _____________________________________







(first)






(last)

Name in Armenian
:

_______
_____________________________

_____________________________________







(first)







(last)

Date of Birth:

________________________
Gender:


Male




Female
{ { {





(dd/mm/yyyy)


Citizenship:

Armenian


Other _______________________________________


Passport Number:

_________________________________


Address:

___________________________________________
________________ _______________________________




(Number and street)




(City)


(Postal code and Country)

Home telephone
:

(______
_)_____________________
Office telephone
:

(________
)
______________
_______


Mobile:

(_______)_____________________

E
-
mail
:

_____________________________________
______


Would you like to receive future
AUA Extension
announcements by e
-
mail
?



Yes


No


If employed, please provide the name of your employer and title of your position:


__________
________________________________________________________________________________________________


How/W
here
did you learn

about
this course
:

By e
-
mail



Through Internet



Through Friends



At work



AUA

poster



Facebook
Other
_______________



Students
who

withdraw
before the second class

will be reimbursed

the
full tuition

fee (except for 5000 AMD administrative
charge
).


APPLICANT SIGNATURE:

________________________________


DATE:

_______________________














(dd/mm/yyyy)

Office use only

Course Fee: ________________




Cash

(
Paid on: ______________)
/



Transfer


(
Org. Name: _________________)



(VAT free


Yes


No)

Student ID: ________________