CAREER PLANNING ORIENTATION FORM
DATE:
CONTACT INFORMATION
NAME:
Student ID:
PHONE:
CELL PHONE:
ADDRESS:
CITY:
STATE:
ZIP:
PERSONAL EMAIL:
BEST FORM OF COMMUNICATION:
EMAIL
PHONE
Best time/s to be reached:
Day
Afternoon
Night
GRAD DATE:
MONTH:
YEAR:
ENROLLMENT DATE:
MONTH:
YEAR:
CAMPUS
Virginia Beach - ECPI
Newport News - ECPI
Raleigh
Northern Virginia
Virginia Beach - MCI
Newport News - MCI
Greensboro
Charlotte
Concord
Greenville
Columbia
Charleston
Richmond S/W - MCI
Online - ECPI
Innsbrook/Glen Allen
Richmond/Moorefield
PROGRAM
Associate
Bachelor
Masters
Network Security
Software Development
Masters/Information Systems
Healthcare IT
Business Administration
Mechatronics
Cloud Computing
Accounting Administration
Biomedical Technology
Simulation & Game Programming
Criminal Justice
Electronics Engineering
Technology
Database Programming
Homeland Security
Maritime Technology
Web Development
CERTIFICATIONS / AWARDS
Please list any relevant professional certifications that you currently hold:
________________
Please list any awards that you received:
CITIZENSHIP
Are you a United States Citizen? YES NO If no, are you able to work in the U.S.? YES NO
In addition to English, what other languages do you speak? English Only Others:
DRIVING RECORD
0 traffic violations in 3 years
1-3 traffic violations in 3 years
4 or more traffic violations in 3 years
CAREER PROFILE AND EXPECTATIONS
Are you willing to relocate for an opportunity? YES ...