Cybertek

B21 Enrollment Agreement BW0

  • Student Information

  • Please note that only full legal name/spelling should be entered.

  • Program

  • Payment Information

  • Any credit card/debit card payment will be subject to a 3% processing fee

  • By checking this box I agree to provide bank or credit card information below and authorize Cybertek as an "Authorized cardholder and user” to make all tuition payments on the due date through the automated payment system.

  • ID Information

  • Please use a scanner or your smartphone. Details and Photo need to be visible.

  • Please use WHITE background. You can use your Smart Phone to take the photo.

  • Emergency Contact Information