Fried Tech Credit Application

Select the Course from the list*
Upload the Certificate of Completion certificate.*
Accepted file types: pdf, jpg, png, jpeg, Max. file size: 64 MB.
Completion Date*
MM slash DD slash YYYY
Instructor*
Personal Information
Name*
First Last
Email*
Cell Phone*
Address*
Street Address City State ZIP Code
Birthday (Include Year)*
Educator ID*
District/ Organization*
Payment Information
Which credit are you applying for?*
- CEUs
- SEMIs
- OSLs
I understand that the payment not received within 3 weeks of submitting the application, my application will be automatically voided*
- Yes
Payment Method*
- $16.50 - Credit/Debit Card
- $15.00 - Check/Money Order
Fried Tech CEUs
Price:
Total Due
$0.00

Please complete the below evaluation about your online course experience.