New Learning Institute Application

Learning Institute Application

PERSONAL INFORMATION

First Name

Middle Name

Last Name

Birth Date

Street

City

State/Province

Zip/Postcode

Cell Phone

I AGREE TO ACADEMY COLLEGE CONTACTING ME VIA SMS MESSAGING

Gender

Ethnicity

Are you a veteran?

Yes No Not Selected

Will you be applying for veterans benefits?

Yes No Not Selected

How did you find us?

Please write a personal statement (2 - 3 sentences) about why you are applying to Academy College and what your career goals are:

Enroll In

APPLICATION FEE AND ACCEPTANCE OF TERMS

An application fee of $40 must accompany this completed application. Notwithstanding anything to the contrary, all tuition, fees, and other charges shall be refunded to students if written notice of cancellation is given within five (5) business days after the day on which the student application is accepted by the school, which is the day it is received, regardless of whether or not the program has started. Learning Institute students must be a graduate of a public high school, private high school, homeschool, alternative learning center, or charter school

SIGNATURE OF STUDENT

DATE

Under 18?

Yes No Not Selected

IF UNDER 18 YEARS OF AGE, SIGNATURE OF GUARDIAN

DATE

EMERGENCY CONTACT INFORMATION

Contact Name

Cell Phone

Relationship