MEA Enrollment
Let us know how we can help you!
Full Name
*
First Name
Last Name
Business Name (if applicable):
Company Name
Reference from Company (name of supervisor)
Date of Birth:
*
22/22/2222
Age and Gender Male or Female
Military service:
Yes/No
Active Duty?
Emergency contact:
Name
Number
Medical Information
*
Do you have any medical conditions we should be aware of?
Do you have health insurance?
Do you need a parental/guardian consent to enroll in this program?
Any broken bones?
Do you feel you can lift 60lbs and work outdoors?
Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date and Time suitable to contact you.
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Course Selection
*
Entire Course (recommended)
GPS Systems
Plans & Blueprints
Estimating and Computing
OSHA Safety
Heavy Equipment
Environmental & Erosion Control
Pipe Installation
Commercial Drivers License
Careers & Development
Other
What is the ideal school start time? (for students in high school)
8:00AM
10:00AM
1:00PM
5:00PM
Other
Enrollment Requirements
*
Must be 18 years old by course completion
Legal US citizenship or work authorization
Able to meet the physical requirements of (standing,lifting,maneuvering)
Do you have a valid driver's license? (CDL training)
Do you have any pending legal restrictions or obligations that could affect your training?
Do you have DWI or convicted Felon on record?
Legal and Policy Agreements
*
Do you agree to comply with the academy's code of conduct and policies?
Do you agree to the academy's liability waver and release form?
Do you consent to being photographed or recorded for academy promotional purposes?
All forms need to be filled out before starting class?
Liability Waiver
Photo/Video release form
Privacy policy agreement
Assistance
*
Would you use financial aid?
You agree the tuition needs to be paid in full two weeks before starting class?
Payment Options & Information you are planning to pay with?
*
Credit Card
Debit Card
Bank Transfer
Check
Other
Signature
Would you like to be notified about promotional services?
Yes
No
How excited are you about this type of training?
5% Skeptical
50% Not sure
100% Full in
Other
Application process?
Worst
1
2
3
4
decent
5
1 is Worst, 5 is decent
Do you recommend a friend?
Name and email address
Continue
Continue
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