Coursera Certificate Sign-Up Form
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Student Information
Name
*
Phone
*
Email
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Gender
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Male
Female
Church
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Archangel Michael (Santa Ana, CA)
Archangel Michael (Simi Valley, CA)
Archangel Michael & Gabriel (Fresno, CA)
Archangel Raphael & St. Mina (Palmdale, CA)
Christ the Savior (Sherman Oaks, CA)
Christ the Good Shepherd (Long Beach, CA)
Holy Annunciation (Inglewood, CA)
Holy Cross (San Marcos, CA)
Holy Resurrection (Los Angeles, CA)
Holy Transfiguration (Chino Hills, CA)
Holy Virgin Mary and St. Pishoy (Los Angeles, CA)
St. Pope Kerellos VI (Westminster, CA)
St. Abanoub & St. Antony (Norco, CA)
St. Antonius (Hayward, CA)
St. Basil (San Diego, CA)
St. Cyril of Alexandria (Irwindale, CA)
St. Demiana (Bakersfield, CA)
St. Demiana (San Diego, CA)
St. George (Bellflower, CA)
St. George & St. Bishoy (Visalia, CA)
St. George the New Martyr (San Jacinto, CA)
St. Gregory (Anaheim, CA)
St. Gregory the Theologian (Buena Park, CA)
St. John (Covina, CA)
St. John Chrysostom (Laguna Niguel, CA)
St. John the Baptist (Oxnard, CA)
St. Justina (Rancho Cucamonga, CA)
St. Marina (Irvine, CA)
St. Mark (Honolulu, CA)
St. Mark (Los Angeles, CA)
St. Mary of Egypt (Santa Clarita, CA)
St. Mary (Victorville, CA)
St. Mary & St. Athanasius (Northridge, CA)
St. Mary & St. John (San Jose, CA)
St. Mary & St. Verena (Yorba Linda, CA)
St. Mary Magdalene (Palm Desert, CA)
St. Mary of Egypt (Santa Clarita, CA)
St. Maurice (Pomona, CA)
St. Mercurius & St. Abraam (Torrance, CA)
St. Mina (Colton, CA)
St. Monica (Newport Beach, CA)
St. Paul (Tustin, CA)
St. Peter & St. Paul (Santa Monica, CA)
St. Thomas the Hermit (Hemet, CA)
St. Verena & Three Holy Youth (Orange, CA)
Other
Select Option
Archangel Michael (Santa Ana, CA)
Archangel Michael (Simi Valley, CA)
Archangel Michael & Gabriel (Fresno, CA)
Archangel Raphael & St. Mina (Palmdale, CA)
Christ the Savior (Sherman Oaks, CA)
Christ the Good Shepherd (Long Beach, CA)
Holy Annunciation (Inglewood, CA)
Holy Cross (San Marcos, CA)
Holy Resurrection (Los Angeles, CA)
Holy Transfiguration (Chino Hills, CA)
Holy Virgin Mary and St. Pishoy (Los Angeles, CA)
St. Pope Kerellos VI (Westminster, CA)
St. Abanoub & St. Antony (Norco, CA)
St. Antonius (Hayward, CA)
St. Basil (San Diego, CA)
St. Cyril of Alexandria (Irwindale, CA)
St. Demiana (Bakersfield, CA)
St. Demiana (San Diego, CA)
St. George (Bellflower, CA)
St. George & St. Bishoy (Visalia, CA)
St. George the New Martyr (San Jacinto, CA)
St. Gregory (Anaheim, CA)
St. Gregory the Theologian (Buena Park, CA)
St. John (Covina, CA)
St. John Chrysostom (Laguna Niguel, CA)
St. John the Baptist (Oxnard, CA)
St. Justina (Rancho Cucamonga, CA)
St. Marina (Irvine, CA)
St. Mark (Honolulu, CA)
St. Mark (Los Angeles, CA)
St. Mary of Egypt (Santa Clarita, CA)
St. Mary (Victorville, CA)
St. Mary & St. Athanasius (Northridge, CA)
St. Mary & St. John (San Jose, CA)
St. Mary & St. Verena (Yorba Linda, CA)
St. Mary Magdalene (Palm Desert, CA)
St. Mary of Egypt (Santa Clarita, CA)
St. Maurice (Pomona, CA)
St. Mercurius & St. Abraam (Torrance, CA)
St. Mina (Colton, CA)
St. Monica (Newport Beach, CA)
St. Paul (Tustin, CA)
St. Peter & St. Paul (Santa Monica, CA)
St. Thomas the Hermit (Hemet, CA)
St. Verena & Three Holy Youth (Orange, CA)
Other
If your church was not listed above, please enter your Church Name and Church Location below:
Church Name (if not listed)
Church Location (if not listed)
Please enter your grade for the current school year (2020-2021)
Grade
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High School
College
Professional
Select Option
High School
College
Professional
Which Certificate Are You Interested to apply to?
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FaceBook Social Media Marketing Professional
Google Project Manager
Google UX Designer
Google Data Analyst
Google IT Support
IBM Cybersecurity Analyst
IBM Data Analyst (Python)
IBM Customer Engagement
Salesforce/ SV Academy Sales Development Rep
How did you hear about this service? (Check all that apply)
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Announced at Church
CEF Mentor
CEF Counselor
Social Media
Friends or Family
Other (Specify Below)
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