Student College Application

Student College Application

Please complete the application for the college admission. Type or print legibly. This Class/Training has a $75.00 registration fee. Once your form is complete, the admissions department will send a welcome letter to confirm your payment has been received, class date, time schedule and location. *These classes will be in-person 10am, at 151 Wythe Parkway Hampton VA 23661.
Student Check List

Be advised that this application includes a $75.00 registration fee at the conclusion.
Personal Information
Full Name

First NameLast Name
Birth Date

MonthDayYear
Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
High School name
College Attended
Graduated
Graduation date

MonthDayYear
Name of Reference
Number of Reference
College name
GPA
Entry date

MonthDayYear
Date
Exit date

MonthDayYear
Date
Certification program

Choose the option below
Choose a program
Please explain in the box why you are interested in this program. (Optional)
Enrollment Agreement

The required registration fee of $75.00 is nonrefundable. Your signature is required and is the agreement to the financial terms of this application for enrollment.
Signature

USDDescription

Student Check List