Legal Name:

Last Name M.I.

Contact Information

Apartment P.O. Box

City State ZIP Country

Telephone Number - Home

Telephone Number - work/alternate

FAX Number E-Mail Address

Personal Information

Education: Less Than High School Diploma High School Diploma GED Career Technology Education Certificate Less Than 2 Years College More Than 2 Years College Associate Degree Bachelor's Degree Master's Degree Doctor Degree

What year did you graduate (If you have not yet graduated, what year will you graduate)? Before 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1982 1983 1984 1985 1986 1787 1988 1989 1990 1992 1993 1994 1995 1996 1797 1998 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Military Aviation Training? Army Navy Air Force Marines No Military Training MOS/AFCS

Have you ever been convicted of any Local, State, or Federal Statutes/Law(s)?

No Yes | If yes please explain.

How did you first hear about Metro Tech? Select One Newspaper Radio TV Commercial TV - Cox Cable channel 18 TV - News Broadcast Printed Catalog Magazine Internet Web Site Internet Chat Room Outdoor Billboard Yellow Pages Friends/Family Employer School Counselor Agency Referral (DHS/JTPA/other) Other

Statement Of Understanding

I understand that by submitting this form I am requesting that my name be placed on the waiting list for the Aviation Career Campus FAR 147 School for Aviation Maintenance Technology. I also understnad that I will be contacted for the next admissioin procedure by MAIL ONLY. I also understand Admission Procedure #2 involves an orientation and assessment examination with a follow up interview.

I further understand that if I fail to attend the orientation and assessment session for which I am notified, I will be dropped from the waiting list.