Student Application Form

Name:*

First NameLast Name
What course are you applying for?*
What campus will you attend?
Phone Number:*

Area CodePhone Number
E-mail Address:*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have a high school diploma or GED?*

YesNoIn Process
Have you worked as a seasonal farmworker in the past 24 months?*

YesNoMaybe, but I'm not sure
Are you a Service Member, Military Veteran or Family Member?*
Are you registered in the selective service?*
to check status visit www.sss.gov
If necessary, are you willing to travel more than 50 miles to start your new career?
Do you have reliable transportation?*
If you do not have reliable transportation, what is your plan to get to and from work after training?
Do you have a Drivers license? *
How were you referred to us?*

Walk-InEmployeeNewspaper AdFacebookTwitterCraigslistOther (please specify)Other
What line of work have you worked in the past? Ex: Restaurant, Industrial, Construction, etc.
What is your Shirt size?*
Based on this size, we will purchase your welding jacket size.
By signing below I acknowledge that I must strictly follow the Southern Industrial Careers Center Student Code of Conduct, attendance and grading policies and follow all of its stated stipulations. Example: No Cellular Phones in shop or class, no jewelry, excellent attendance, Tardiness is unacceptable, homework and reports are due every Friday.
Signature
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