Registration Form

Please complete the registration form and submit your payment to secure your seat. A $3.00 convenience fee will be added to the total registration cost. Processing time is 24–48 hours (excluding weekends and holidays). All registrations are non‑refundable.

Date of Application

Address Program Program Start Date

Personal Information

First Name Last Name Date of Birth (Must be 18+)

City State Zip Code Cell Phone Please text me with information regarding the courses offered. MSG and data rates may apply. I can text Stop at anytime to end.

Sex Male Female Trans Female (male to female) Trans Male (female to male)

Email Address

Health Background

Are you on any medications? If yes, what are they? Do you have a medical diagnosis? If yes, what is your diagnosis? Would your diagnosis affect your performance in the program? If so, in what manner?

Educational Experience

Did you graduate from college? Highest Level of School Completed Who is your current employer? If applicable, what is their phone number? Did you graduate from high school? Emergency Contact Information (Please include name, relationship, phone number, and address)

Criminal Background Information

Have you ever been arrested? If yes, why? Have you ever been expunged or pardoned of a crime? If yes, please further explain.

Do you have a misdemeanor? Yes No

Do you have a felony? *Please note that felons will be rejected* Yes No

Were you convicted?

Pop out Full screen

I acknowledge that submitting payment confirms my acceptance of this policy and that chargebacks or disputes will not result in a refund.

Fees

Registration Fee (Non-refundable deposit) Online Class Materials Only (Non Refundable) Tuition Please upload a copy of your state issued ID.

Submitting this form, I declare that the information contained in this application is true and complete. If information is false, I will be expelled.

Signature

Date: Wednesday, 6 May 2026 (EDT)

Name:

Type your name to sign this document:

Typing name is equivalent to a handwritten signature

Scan this QR code with your phone: