New Online Application

Personal Information

First Name

Last Name

Social Security No

Cell Phone

Street

City

State/Province

Zip/Postcode

Email

Birth Date

Ethnicity

Program

Program Start Date

Preferred Schedule

Campus

Financial Aid

Yes No Not Selected

Cash Pay Student

Yes No Not Selected

Are you a VA student

Yes No Not Selected

If yes, what type(s)

Please Upload Drivers License or State ID

Please Upload High School Diploma,GED, or Transcripts

The State License Department may require a background and criminal record check prior to a licensing test. Do you have any incidents in your past that may cause concern?

Yes No Not Selected

Do you have a documented learning disability?

Yes No Not Selected

Education

Name of High School or GED Testing Center:

High School Graduation Date

Do you have any other schools to list

Yes No Not Selected

Name of School

Area of Study

Last Attended

Are you currently attending a school right now?

Transfer Students

Name of School

State

Currently Attending?

Yes No Not Selected

Last Attended

Area of Study

Emergency Contact Information

Emergency Contact Name

Relationship to Student

Phone

Health History

Do you have any physical or mental conditions, including but not limited to injuries or disabilities that could affect or prevent you from fulfilling the requirements of the program?

Yes No Not Selected

Are you taking any prescribed medication that may affect or impair your ability to participate in the program?

Yes No Not Selected

If you checked yes to anything above please describe in complete detail.

Thank You!

Check Your Email! For the Next Steps!