Registration

Student Application

Full Name:

Date of Birth:

Email:

Address:

Cell Phone:

Home Phone:

Work Phone:

Employer:

Position:

How long have you been employed here?

Address:

Phone:

Name:

Phone Number:

Relationship:

Address:

How did you hear about us?

Which semester are you applying for?

Which days can you attend class?

Additional comments:

I certify that all information entered is correct

I understand the pick up date is pending and will be given 1-2 weeks prior to the first day of class. The first initial payment will be due on pick up day to pick up books and tablets.

I understand that in order to reserve my spot, I must pay the non-refundable fee of $100 following this form. To show you agree, please type "100" into the field below

Student Application

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