Application Form

Complete the application below and click the 'submit' button when finished. Upon acceptance to this program, the College of Continuing Education will send you a Registration Agreement which must be completed, signed and faxed to (916) 278-4865 in order for your application to be valid.

 

*Required Fields

 
Applicant
  Formal Name (this name will appear on formal documents, i.e., certificate)
First Name *   Last Name *
 
 
  Preferred Name * (for nametags and class rosters):
 
  Working Title *
  
 
Agency / Department / Organization *
   Division
   Office/Unit
 
  Civil Service Classification (if applicable)

  
  Mailing Address *
  
 
City *   State *   Zip *
   
 
  Telephone*
  
  Email *
  
  How did you hear about the Information Security Leadership Academy? *
  
     
Applicant Demographic Information
  Gender *
  
 

Sacramento State Alum? *
Yes    No

  
  Highest Level of Education *
  
     
Position
  Description of current duties: *
  
  List of previous experience and dates: *
  
   
Applicant's Manager
 
First Name *   Last Name *
 
 
  Working Title *

  
 
Agency / Department / Organization *
   Division
   Office/Unit
 
  Civil Service Classification (if applicable)
 
  Mailing Address *
  
 
City *   State *   Zip *
   
 
  Telephone *
  
  Email *
  
     
Short Answer Questions  
  1. In 500 words or less, please answer the following question: How would you and your organization benefit by your participation in the Information Security Leadership Academy? *
  
 

2. What is a pressing information security topic/issue/challenge facing your organization? Why? *

  
     
Course Information
 
Program Title Start Date Price
Information Security Leadership Academy February 19, 2010 $4,299
 
     
By submitting this application, I understand that I am committing the time and effort for all six courses of the program.

I further understand that, upon acceptance, the application becomes valid when the Registration Agreement is received by the College of Continuing Education.

 

Click here to acknowledge that you agree to the terms of this application. *
If you have questions, please contact:

CCE Registration

(916) 278-4433
cceinfo@csus.edu