General Student Enrollment Form

This person was recruited by: (required)

First name: (required)

Middle name:

Last name: (required)

Address: (required)
Street City State Zip Code

Email address: (required)

Phone number: (required)

Date of birth: (required)

Social Security Number: (required)

Gender: (required)
MaleFemale

U.S. Citizen:
YesNo

MI Works!:
YesNo
Location:

Program interested in: (required)
600 Clock Hours (Full)240 Clock Hours (Partial)

Class interested in: (required)

Class Start Date:

Click to upload copy of Driver's License/State ID:
[multilinefile* multilinefile-133 "Upload files"]

Method of Tuition Payment: (required)

Comments:

PLEASE NOTE: IT IS MANDATORY THAT PROOF OF SCHOOLING (GED, DIPLOMA, TRANSCRIPTS) BE PROVIDED BEFORE BEGINNING CLASS.