PSB Information Request Form

Name Street address City/State/Zip  High School Graduate  Yes  No     Year Graduated  2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 Home Phone   Work Phone ext FAX E-mail URL Please select subject of interest from below: (1 or More) Business Administration                 A+ Training Medical Billing & Coding                Information Technology Office Administration                       Microsoft Certification Training Please select program schedule: Days/Career Evenings/Nights   Please select the Representative you wish to speak to or have spoken to already: (If Applicable) Jean Paul Richardson  Melitza Velez Jessica Melendez   Jessica Grube Please take a moment to rate the Pennsylvania School of Business Web Site: Please only select one option             Poor             Not So Good             Average             Good             Very Good How did you hear about us? Please Select B 104 WLEV 100.7 Cat Country 96FM 99.9 The Hawk Newspaper Advertisement Morning Call Online School Website (search engine) Microsoft Web Site CompTIA Web Site CIW Certified Web Site Career Fair Yellow Pages Computer Show Referral Any comments or suggestions please insert here: