<% ' FP_ASP ASP Automatically generated by a Frontpage Component. Do not Edit. On Error Resume Next Session("FP_OldCodePage") = Session.CodePage Session("FP_OldLCID") = Session.LCID Session.CodePage = 1252 Session.LCID = 1033 Err.Clear strErrorUrl = "" If Request.ServerVariables("REQUEST_METHOD") = "POST" Then If Request.Form("VTI-GROUP") = "0" Then Err.Clear Set fp_conn = Server.CreateObject("ADODB.Connection") FP_DumpError strErrorUrl, "Cannot create connection" Set fp_rs = Server.CreateObject("ADODB.Recordset") FP_DumpError strErrorUrl, "Cannot create record set" fp_conn.Open Application("application_ConnectionString") FP_DumpError strErrorUrl, "Cannot open database" fp_rs.Open "Results", fp_conn, 1, 3, 2 ' adOpenKeySet, adLockOptimistic, adCmdTable FP_DumpError strErrorUrl, "Cannot open record set" fp_rs.AddNew FP_DumpError strErrorUrl, "Cannot add new record set to the database" Dim arFormFields0(16) Dim arFormDBFields0(16) Dim arFormValues0(16) arFormFields0(0) = "S1" arFormDBFields0(0) = "S1" arFormValues0(0) = Request("S1") arFormFields0(1) = "Option_CCNA" arFormDBFields0(1) = "Option_CCNA" arFormValues0(1) = Request("Option_CCNA") arFormFields0(2) = "Contact_HomePhone" arFormDBFields0(2) = "Contact_HomePhone" arFormValues0(2) = Request("Contact_HomePhone") arFormFields0(3) = "Personal_Sex" arFormDBFields0(3) = "Personal_Sex" arFormValues0(3) = Request("Personal_Sex") arFormFields0(4) = "Contact_Title" arFormDBFields0(4) = "Contact_Title" arFormValues0(4) = Request("Contact_Title") arFormFields0(5) = "Option_MCSE" arFormDBFields0(5) = "Option_MCSE" arFormValues0(5) = Request("Option_MCSE") arFormFields0(6) = "Contact_MiddleInitial" arFormDBFields0(6) = "Contact_MiddleInitial" arFormValues0(6) = Request("Contact_MiddleInitial") arFormFields0(7) = "Contact_Email" arFormDBFields0(7) = "Contact_Email" arFormValues0(7) = Request("Contact_Email") arFormFields0(8) = "Contact_FirstName" arFormDBFields0(8) = "Contact_FirstName" arFormValues0(8) = Request("Contact_FirstName") arFormFields0(9) = "Personal_DateOfBirth" arFormDBFields0(9) = "Personal_DateOfBirth" arFormValues0(9) = Request("Personal_DateOfBirth") arFormFields0(10) = "Option_MOUS" arFormDBFields0(10) = "Option_MOUS" arFormValues0(10) = Request("Option_MOUS") arFormFields0(11) = "Option_MCP" arFormDBFields0(11) = "Option_MCP" arFormValues0(11) = Request("Option_MCP") arFormFields0(12) = "Option_Net+" arFormDBFields0(12) = "Option_Net+" arFormValues0(12) = Request("Option_Net+") arFormFields0(13) = "Contact_WorkPhone" arFormDBFields0(13) = "Contact_WorkPhone" arFormValues0(13) = Request("Contact_WorkPhone") arFormFields0(14) = "Contact_LastName" arFormDBFields0(14) = "Contact_LastName" arFormValues0(14) = Request("Contact_LastName") arFormFields0(15) = "Option_A+" arFormDBFields0(15) = "Option_A+" arFormValues0(15) = Request("Option_A+") FP_SaveFormFields fp_rs, arFormFields0, arFormDBFields0 If Request.ServerVariables("HTTP_USER_AGENT") <> "" Then FP_SaveFieldToDB fp_rs, Request.ServerVariables("HTTP_USER_AGENT"), "Browser_type" End If If Request.ServerVariables("REMOTE_HOST") <> "" Then FP_SaveFieldToDB fp_rs, Request.ServerVariables("REMOTE_HOST"), "Remote_computer_name" End If FP_SaveFieldToDB fp_rs, Now, "Timestamp" If Request.ServerVariables("REMOTE_USER") <> "" Then FP_SaveFieldToDB fp_rs, Request.ServerVariables("REMOTE_USER"), "User_name" End If fp_rs.Update FP_DumpError strErrorUrl, "Cannot update the database" fp_rs.Close fp_conn.Close FP_FormConfirmation "text/html; charset=windows-1252",_ "Form Confirmation",_ "Thank you for submitting the following information:",_ "application.html",_ "Return to the form." End If End If Session.CodePage = Session("FP_OldCodePage") Session.LCID = Session("FP_OldLCID") %> New Page 1

Cisco Networking Academy Application Form


This form is designed to assist in collecting information about the expected number of students to enroll in the Cisco Networking Academy.  This form is also utilized to collect information regarding the background, skills, and interests of those prospective students.  When appropriate, please provide as detailed answer as possible as  this will help us with data collection process. 

  1. Please provide the following contact information:

    First Name
    Last Name
    Middle Initial
    Title
    Work Phone
    Home Phone
    E-mail
  2. Please identify and describe yourself:

    Date of Birth
    Sex Male Female
  3. Do you currently hold any industry certifications ?

            Yes    No

  1. If yes, Please check all that applies.

    A+
    Net+
    MCP
    CCNA
    MCSE
    MOUS

  2. Which one of the following Interfaces do you prefer?

    Command Line Interface (CLI)    Graphical User Interface (GUI)

     

     

  3. Please list previous networking classes you have successfully completed before:

     


Author information goes here.
Copyright © 1999 [OrganizationName]. All rights reserved.
Revised: October 18, 2001