College Admissions Form

training and enrollment form

Enter your admission information below
Name

First NameMiddle InitialLast Name
Birth Date

MonthDayYear
Gender

MaleFemale
Of which country are you a citizen?
Phone
E-mail Address
example@example.com
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact

First NameLast Name
Relationship
Email
example@example.com
Phone Number
Please enter a valid phone number.
Do you speak any languages other than English?

YesNo
Please list them

Education
High School or Equivalent Name
Graduation Date

MonthDayYear
Date
School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Why are you interested in this apprenticeship training program?
Have you ever been convicted of a felony or misdemeanor?

YesNo
Do you need Financial aid?

YesNoOther
The participate and or student hereby agree and consent to be trained by this apprenticeship training program which consist of civilian and or prior or active military law enforcement or medical first responder personnel of which is not affiliated with any particular government agency and you hereby consent and authorize us to provide to you the common knowledge of such training obtained through and by the courses offered. you as the participate or student hereby waive any and all rights of tort or suit against said provider, sponsor or officers of the training institute for any reason and hereby agree not to disclose any material or information obtained from said institute nor shall participate or student transmit or record any data obtained nor transfer said material or data through or to any third party without the express written consent of the provider and sponsor of said training institute. participate and or student agree's that he/she may be sued for breach of this contract and application for failure or breach of contract herein. participate herein agree's and consent to act as private contractor for and on behalf of said institute. participate understands that he/she may be certified under the policies, procedures and bylaws of the training institute. the participate herein certify that he/she meets the requirements for said program: Program requires: -Proof of high school diploma or equivalent, Government-issues photo ID, Social Security Card, Negative TB test or chest X-ray (within 12 months), Physical examination (within the last 12 months). do you agree to the above?

YESNO
I certify that all information provided in this application is accurate and correct.

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training and enrollment form

Education