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Program Information
Contact Information
Emergency Contact Information
Employment Information
Additional Information
Additional Information
Required
is required
is Required
First Name
Required
Middle Name
Required
Last Name
Required
Suffix
Required
-- choose one --
I
II
III
IV
Jr.
Sr.
V
Email Address
Required
Social Security Number
Required
Date of Birth (MM/DD/YYYY)
Required
Gender
Required
-- choose one --
Female
Male
Unknown
Are you Hispanic or Latino?
Required
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NO
YES
Select one or more of the following races:
Required
White
Black or African American
Asian
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
Citizenship Status
Required
-- choose one --
Non-Resident Alien
Resident Alien
US Citizen
is Required
Home Address
Street 1
Required
Street 2
Required
City
Required
State
Required
-- choose one --
ALABAMA
ALASKA
AMERICAN SAMOA
ARIZONA
ARKANSAS
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
DISTRICT OF COLUMBIA
FLORIDA
GEORGIA
GUAM
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
PUERTO RICO
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGIN ISLANDS
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING
Zip Code
Required
Zip Code Extension
Cell Phone
Required
Cell Phone Area Code
Cell Phone Exchange
Cell Phone Number
Cell Phone Extension
Ext:
Work US Phone
Required
Work US Phone Area Code
Work US Phone Exchange
Work US Phone Number
Work US Phone Extension
Ext:
is Required
Please provide the following information as required by state and federal agencies for statistical and research purposes only.
Emergency Contact
Required
Emergency Contact Email
Required
is Required
Highest education level
Required
-- choose one --
College
GED
High School
Program:
Required
-- choose one --
Commercial Truck Driving (CDL)
Basic Welding
Nail Technician
Phlebotomy
Vehicle Safety Inspector
Emissions Inspector
Forklift Operator Training
Plumbing Apprenticeship
Enhanced Vehicle Safety
Driver's Education
Anticipated Starting Semester
Required
-- choose one --
CDL - Class A 24/25
Phlebotomy 24/25
Driver Education 24/25
Nail Technician 24/25
Welding 24/25 (Basic/Fund.)
Vehicle Safety Inspector 24/25
Emissions Inspector 24/25
Forklift Operator Training
Vehicle Safety - Cat. IV 24/25
Plumbing 24/25
Employer
Required
is Required
School District
Required
-- select one --
Central York School District
Dallastown Area School District
Dover Area School District
Eastern York School District
Hanover School District
Northeastern School District
Red Lion School District
South Eastern School District
South Western School District
Southern York School District
Spring Grove School District
West York School District
York City School District
York Suburban School District
Other
Applicant Signature
Required
Please type your full name and date.
Reason for taking course:
Required
-- select one --
Apprenticeship
Change Career
Job Preparation
Upgrade/Supplemental Skills
Other
Employment Status
Required
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Full Time
Part Time
Unemployed
Retired
Application Date (MM/DD/YYYY)
Required