New Student Registration

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Step 1 of 2

Contract Hours Fees:

Layout

First Name

Last Name

Phone

Social Security Number:

Birth Date:

Age:

Driver’s License #:

U.S. Citizen

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Contract Start:

Contract Ends:

Clock Hours Start:

Clock Hours Completed:

Program

Schedule:

Daytime
Evening

Instructors Name:

Makeup Days: All students are allowed one makeup day per month, if needed.

Contract Cost and Payment Terms: The student and sponsor (if applicable) agree to pay the school the tuition and fees for the selected program according to the approved payment plan. The school may, at its discretion, prevent students from attending class until all outstanding balances are paid. Payment methods include cash, check, money order, credit card, or approved payment plan. Students are responsible for paying all tuition, fees, and loan repayments.

If using grant/other who was funding source?

If loan was chosen who was the lender?

Tuition Cost:

Registration Fee:

Books/ Kit Bags:

(non-refundable)

Additional Fees:

Total Amount

# of Monthly Payments:

Monthly Payment Amount:

Price: $0.00

Deposit:

Payments Due On:

Amount Paid:

Amount Owed:

Student Signature

Clear Signature

Date:

Admissions Signature

Clear Signature

Date:

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