Enrollment Application
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 date are you applying for?
November 10-November 21
December 1-December 12
Which class are you interested in?
*
In person only 8am-4:30pm.
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.
*
Continue
Should be Empty: