Goshen Application for Admissions

APPLICATION FOR ADMISSION

GOSHEN CAMPUS
AISLING TRUCK ACADEMY prohibits discrimination against its customers, employees, and applicants for employment and student applicants on the basis of race, color, national origin, age, disability, sex, gender identity, religion, reprisal, and where applicable, political beliefs, marital status, familial or parental status, sexual orientation, or all or part of an individual's income is derived from any public assistance program, or protectred genetic information in employment or in any program or activity conducted or funded by AISLING TRUCK ACADEMY.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Have you ever applied to this school before? If so, when?*
Have you ever attended this school before? If so, did you graduate? If you did not graduate, what was the reason you left?*
Cell Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Message Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Date of Birth*

MonthDayYear
Date
Are you a U.S. Citizen?*

YESNO
Have you served in the U.S. military/armed services?*

YESNO
If you served in the U.S. military/armed services, were you Honorably Discharged?*

N/AYESNO
Emergency Contact Name*

First NameLast Name
Emergency Contact Relationship*
Emergency Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Education: Secondary Education*

High School GraduateGEDDid not complete high school
Year Graduated or Received GED*
I have completed the following post-secondary education:*

Have not attended collegeSome collegeCertificate program at community collegePrivate career school certificate/diplomaApprenticeship trainingAssociate degreeBachelor degreeMaster degreeDoctorate or professional degreeOther
List the name and location of High School and post-secondary institution(s) you attended:*
Type a Are you currently employed?*

Yes, 35+ hours/weekYes, less than 35 hours/weekNo, not at this timeRetired
I am pursuing admission for the following reason:*

Career preparation and employmentPersonal development/ Self improvementAdvanced training/Continuing education
I intend to enroll in the following program:*

PROGRAM 101E CLASS A CDL DRIVER TRAININGCDL REFRESHER TRAINING
Is there any other information you would like to provide that might impact your abilty to benefit from the program (i.e. physical limitations, dyslexia, attention deficit disorder, etc.)*
Aisling Truck Academy collects ethnics/race information as requested by the Higher Education Coordinating Commission, our licensing body.

Hispanic/LatinoAmerican Indian/Alaskan NativeAsianAfrican AmericanNative Hawaiian/Pacific IslanderWhiteOther
Should be Empty:

APPLICATION FOR ADMISSION