JJC: Technical Dept - OPT Student Info Net Registration Form

Technical
Department

"Your Future...Your Way...Your Community College"

Technical Department
Orthotics & Prosthetics Tech
OPT Home
Open House

OPT News

Degrees/Certificate Programs
● A.A.S. Degree Info.
● Certificates of Achievement:
- Orthotics
- Prosthetics
● Certificates of Completion

Student Program Information
● Instructor Information
● Student Info Net Registration
● Course / Syllabi list
● Professional Interviews
● Program Requirements

OPT Industry Links:
● Professional
● Education
● Points of Interest
For more information about careers and schooling in O & P

OPT
Info Net Registration Form

For more information, contact:

Michael Brncick
OPT Program Coordinator/Advisor
Office: T1061
Phone: 815-280-2219
Email: mbrncick@jjc.edu

Please complete the form below and press submit. Note the **required fields.

**Name:
**Address 1:
Address 2
**City
**State
**Zip Code
**Contact Phone # 1
Contact Phone # 2
**E-mail 1
E-mail 2
**Are you a current student at JJC? Yes No
**If so, which program/curriculum are you registered in? OPT Other
**If other, explain:
**Interests: (Check All That Apply)
OPT Program Existing JJC OPT student
Would you like information regarding the OPT program? Yes
Would you like to be contacted by an OPT program advisor? Yes
How did you hear about this?