2022 Virtual Reality Certificate Application

Personal Information

Name*

First Middle Last

Home Address*

Street Address Address Line 2 City State ZIP Code

Home Phone

Cell Phone

Personal E-Mail Address*

Education Completed*

Employment/Vocation Information

Employer

Position/Title

Employed at current employer since (month/year)

Employer’s Address

Street Address City State ZIP Code

Work Phone

Work E-Mail Address

Supervisor’s Name

Title

Phone Number

Email Address

Provide a brief description of responsibilities in your current vocation (i.e. work, volunteerism, or at-home responsibilities)*

Please list additional educational background, including occupation, vocational and technical training, as well as any other special skills you have.*

What do you hope to get out of this program?*

Payment

Payment Type*

Pay by cash/check: $1,000
Pay by credit card: $1,030 (includes a $30 service fee)

Total Credit Card Charge

$0.00

Please send cash/check payment to:

Craig School of Business
Missouri Western State University
4525 Downs Dr | Popplewell Hall 208
St Joseph, MO 64507

For more information, contact Teresa Buttz or Annette Weeks at (816) 271-5615 or (816) 271-4283.

After you click the submit button below, you will be redirected to the payment gateway. Please go through the payment process completely, being sure to click on the "continue" button in Touchnet at the end, and save your payment confirmation email.