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First Name^*

Last Name^*

Date of Birth^*

Social Security Number^*

Email^*

Phone Number^*

Street Address^*

City

State^*

Zip Code^*

Are you a U.S. Citizen^*

Please share why you desire to become an HVAC Tech^*

How did you hear about W.C.S.E.?^*

I own or have access to a smart phone and/or computer/laptop with internet access?^*

Class^*

Section^*

Have you been enrolled in a previous training program^*

Have you been terminated from a program^*

If you answered yes to the previous question. Please explain the reason you were terminated or unable to complete the program.

Have you ever been convicted of a felony?^*

If you have been convicted of a felony, please explain

High School Name^*

High School City & State^*

Did you graduate from High School?^*

College/University Name

College/University City & State

Did you graduate with a college degree?^*

Did you receive testing accommodations or support at a previous school?^*

Do you have any known learning disabilities? If yes, please list them. If no, type N/A.^*

Emergency Contact^*

Emergency Contact Email^*

Emergency Contact Phone^*

What is your preferred tuition payment type? Note: Any adjustments to your selected plan will incur a $30 fee^*

Payment in full 2 weeks before class start date 50% 2 weeks before class start date + 50% 2 weeks before last day of class

You may be eligible for financial aid if you are experiencing one or more of the following:^*

You are low income You are receiving SSI You are receiving disability You are currently homeless You are in foster care or recently aged out of foster care You are a woman over 21 and have had at least 24 consecutive months as a non-student None of the above apply to me

Confirmation & Signature (Typing your full name below certifies your consent and agreement)^*

I certify that my answers on this document are true and complete to the best of my knowledge. If I am accepted into the Institute, I understand that any false or misleading information contained in my application or interview, regardless of the time of discovery, may result in my dismissal from the program. I understand that all information on this application is subject to verification and I consent to criminal history background checks. I also consent to references and former employers and educational institutions listed being contacted.

Fees

Mandatory Fees
	Application Fee (non-refundable)	50
	Total	50.00

WCSE HVAC Tech Course

Registration Form

WCSE HVAC Tech Course

Registration Form

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