INQUIRY DATE

TAKEN BY

P. CENTER

TAX SCHOOL REGISTRATION FORM

NAME

ADDRESS

CITY

STATE

ZIP

PHONE (DAY)

PHONE (EVENING)

OTHER

EMAIL

SOURCE OF INQUIRY
BALLOONS

DIRECT MAIL

TV (NATIONAL/CABLE)

FRIEND/RELATIVE

PRESS RELEASE

EARN CE CREDITS
NON PTIN HOLDERBECOME RTRP
EMPLOYMENT WITH
JACKSON HEWITT

NEWSPAPER AD

BANNER/SIGN

RADIO

TRANSIT CARD PROFILER QUESTION WEBSITE/INTERNET FLYER/COUPON ADVERTORIAL (OTHER)

REASON FOR INTEREST

PTIN HOLDER-RTRP TEST

CLASSIFIED AD

LEARN TO PREPARE OWN

RETURN

PREFERRED LEARNING METHOD

FOLLOW UP

CLASSROOM

BROCHURE PACKET MAILED

DATE:

ONLINE

FOLLOW-UP PHONE CALL

DATE:

PTIN HOLDER

POSTCARD MAILED

DATE:

YES

FREE SEMINAR INVITE MAILED

DATE:

NO

OTHER

DATE:

LEARN COMPUTER SKILLS

SELF-DEVELOPMENT
OTHER
UNKNOWN

ENROLLMENT -- (STAPLE ENROLLMENT AGREEMENT AND OFFICE COPY OF RECEIPT TO THIS FORM)
DATE REGISTRATION ENTERED IN E-SERVICES:
CLASS LOCATION 1ST CHOICE:

DAY

EVE

SAT.

SUN.

CLASS LOCATION 2

CHOICE:

DAY

EVE

SAT.

SUN.

CLASS LOCATION 3 CHOICE:

DAY

EVE

SAT.

SUN.

ND

RD

COURSE: 12-WEEK

8-WEEK

COMPUTER

DATE BOOKS ISSUED:

TOTAL DUE

AMOUNT PAID

SEMINAR

ONLINE

FEE QUOTED:

ISSUED BY:
DATE

PAYMENT TYPE

BOOKS ISSUED:
REMAINING BALANCE

EMPLOYMENT INFORMATION
HIRED

NOT HIRED

AVAILABILITY (IF HIRED)

DAYS

EVENINGS

BOTH

COURSE COMPLETION
REGISTERED COURSE:
DATE COMPLETED:

IF INCOMPLETE, # OF SESSIONS COMPLETED:

WHY WASNT COURSE COMPLETED? (INDICATE REASON GIVEN)________________________________________________________________________________________

NOTES