Enrollment Application
A $50.00 application fee is required for background checks.
Name
*
First Name
Last Name
Other names used (e.g. maiden name)
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Alternate phone number
Social Secuity Number
Date
*
-
Month
-
Day
Year
Date
Date of birth
*
Emergency contact
*
Name/ Relationship/ Number
Gender
*
Male
Female
Other
Ethnic Background
East Asian or Pacific Islander
Central Asian or Middle Eastern
Black, Non-Hispanic
Hispanic or Latin American
Native American or Alaskan Native
White, Non-Hispanic
Citizenship Status
*
U.S. Citizen
Permanent Resident or Resident Alien (provide Alien Registration Card, form I-551
Refugee or Asylum Status (provide proof of status from USCIS)
Educational Background
*
High School Graduate or GED
Associate Degree or less
Bachelor's Degree
Graduate Degree
Last Highschool Attended
Graduation Date
Which class are you interested in?
*
Hybrid (available starting Dec. 1st)
How do you plan to pay tuition?
*
Pay tuition in full
Deposit + payment plan
Other
Driver's License/ State Identification Card
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Social Secuity Card
Browse Files
Drag and drop files here
Choose a file
Cancel
of
I certify that all answers given to questions in this application are correct and complete to the best of my knowledge. I understand that failure to answer questions honestly may result in denial of application.
*
My Products
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Application Fee
Application fee is non-refundable and will be applied towards background check.
$
50.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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