Student Application Form

Thank you for your interest in applying to Xtech Minds. Please complete the form below to provide us with the necessary information to process your application. We are excited to learn more about you and how our program can help you achieve your career goals in technology. Please take your time to fill out this form carefully, as we use this information to determine your eligibility.

Please complete the application form below. Ensure all fields are filled out accurately.

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Full Name

Phone Number

Date of Birth

Current Address

Address Line 1

City

State

Zip Code

Professional Background

Educational History

Current Occupation

Program Information

Specify Any Please

Choose Your Program

Program Timeline

Please select your preferred program from the available options.

(Online - Part-Time) Start Date: April 02, 2025 - End Date: June 02, 2025 - Graduation Date: June 14, 2025

Online Learning Comfort
This program is fully online. Are you comfortable learning in an online environment?

Online Learning Comfort

Motivation for Joining the Program

Previous Experience in Coding

Financial Information

Tuition Expectations
How do you intend to pay for Xtech Minds?

Tuition Expectations

Out of pocket financing
Scholarship assistance (we also accept external scholarships)
Other (please specify):

Financial/Scholarship Requirements

Demographics

This information helps us with scholarships and tuition assistance. Your responses are optional.

Gender Identity:

Prefer not to say

Disability Status

Do you identify as having a disability?

No
Prefer not to say
Yes (please specify)

Additional Information

LinkedIn Profile or Personal Website (if applicable)

Resume/CV Upload your most recent resume or CV

Click or drag a file to this area to upload.

Any additional information or questions you may have

Consent and Agreement

If accepted, I acknowledge that I will be required to:
Commit to the program's schedule and requirements
Participate actively in the online sessions

Consent:

I consent to Xtech Minds collecting and processing my personal data for my application and confirm that I have reviewed the program's tuition requirements.

Xtech Minds