Student Information Collection Form
General Information
Name
*
First Name
Last Name
Email
*
example@example.com
Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Birth Date
*
-
Month
-
Day
Year
Date
Ethnicity*
Please Select
Prefer Not to Answer
African American
Hispanic / Latino
Asian
Caucasian
Native American / Alaskan
Middle Eastern
Other
Gender*
Prefer Not Answer
Male
Female
Other
Course Interest*
Please Select
Electrical
Solar
HVAC
Construction Technology
OSHA 30
Highest Level of Education
*
GED or Higher required
Are you a U.S. Military Veteran?
Yes
No
Which semester are you looking to start?
*
Fall 2025
Winter 2025
Spring 2025
Summer 2025
Unsure
Interested in Day or Eve?
Day
Evening
This is a fill-in-the-field. Please add appropriate
blank
fields and text.
Your County of Residence?
Submit
Should be Empty: