First Name *

Last Name *

Email Address *

Phone Number *Best way to contact. (Cell phone/Home Phone/Work Phone)

Date of Birth *

Permanent Address *

Apartment, suite, etc

City *

State/Province *Must be located in Virginia

Zip Code/Postal Code *Must be located in Virginia

Complete the information below only if you have no other way to document your income. All of the boxes below must be checked and all questions answered. Failure to complete this form may result in denial of your application.

Current EmployerIf no current employer 'N/A' is an acceptable input.

Please explain as to why you cannot provide documentation from your employer

Please check all applicable choice(s). *

I get paid in cashI do not get pay checksI do not get pay stubsI cannot get a letter from my employer. Explain why:

My cash income is $ *

USD

How Often? *

How many people are in your household?

Applicants/Recipients/Program Participants

must read the following and sign below Under penalty of perjury, I certify that the information presented in this certification is true and accurate to the best of my knowledge. I understand that providing false representations herein constitutes an act of fraud. False, misleading or incomplete information may result in the termination and repayment of my assistance and I may be subject to a civil penalty, plus damages under False Claims Act (31 U.S.C 3729).

Signature *

Date *

Please check all that apply for each member of the household *

Loss of IncomeReduced IncomeIncreased Childcare ExpensesIncreased Medical ExpensesIncreased Rent or Mortgage PaymentsI cannot get documentation proving how COVID-19 has impacted my household. Explain why:

Please explain as to why you cannot provide documentation proving COVID-19 household impact

The types of documentation that are acceptable include, but are not limited to, a letter or notice from employer, establishing proof of reduction in work hours or proof of employer/ business shut down due to COVID19, medical bills related to a COVID-19 diagnosis or treatment, childcare bills, rent/mortgage bills, etc

Applicants/Recipients/Program Participants

must read the following and sign below. Under penalty of perjury, I certify that the information presented in this certification is true and accurate to the best of my knowledge. I understand that providing false representations herein constitutes an act of fraud. False, misleading or incomplete information may result in the termination and repayment of my assistance and I may be subject to a civil penalty, plus damages under False Claims Act (31 U.S.C 3729).

Signature *

Date *

Course List

Attendance, Cancellation and Refund Policy

I, the student, understand the Attendance Policy. *

YesNoAttendance Policy: You cannot miss more than 2 instructional days. On the 3rd absence student will be excused from the course and will forfeit all monies paid. There are no refunds for deposits and payments submitted for the course provided.

I, the student, understand. *

YesNoThe school does not accept credit for previous education, training, work experience (experimental learning), or CLEP. 2. The School does not gurantee job placement to graduates upon program/course completion or upon graduation. 3. the school reserves the right to reschedule the program start date when the number of students scheduled is too small. 4. The school will not be responsible for any statement of policy or procedure that does not appear in the school catalog. 5. The school reserves the right to discontinue the student's training for unsatisfactory progress, nonpayment of tuition or failure to abide by School rules. 6. Information concerning other Schools that may accept the School's credit towards their programs can be obtained by contacting the office of the President. It should not be assumed that any programs described in the Schools catalog could be transferred to another institution. Any decision of the receiving institution. 7. This document does not constitute a binding agreement until accepted in writing by all parties. There are no refunds for deposits and payments submitted for the courses provided.

I, the student, acknowledge. *

YesNoI hereby acknowledge receipt of the School's catlog dated which contains information describing programs offered, and equipment/supplies provided. The School's catalog is included as a part of this enrollment agreement, and I acknowledge that I have/will receive a copy of this catalog. 2. Also, I will carefully read the copy of this enrollment agreement. 3. I understand that the School may terminate my enrollment if I fail to comply with attendance, academic and financial requirement or if I disrupt the normal activities of the School. While enrolled in the School, I understand that I must maintain Satisfactory Academic Progress as described in the School catalog and that my financial obligation to the School must be paid in full before a certificate may be awarded. 4. I also understand that this institution does not gurantee job placement to graduate upon program/course completion or upon graduation. There are no refunds for the deposits and payments submitted for the courses provided.

I, the student, accept this contract. *

YesNoI, the undersigned, have read and understand this agreement and acknowledge receipt of a copy. It is further understood and agreed that this agreement supersedes all prior or contemporaneous verbal or written agreemens and may not be modified without the written agreement of the student and the School Official. I also understand that if I default upon this agreement I will be responsible for payment of any collection fees or attorney fees incurred by the school. There are no refunds for deposits and payments submitted for the courses provided.

Signature *

Date *

Please check all applicable choice(s). *

Applicants/Recipients/Program Participants

Please check all that apply for each member of the household *

Applicants/Recipients/Program Participants

Course List

Please select all course(s) below that you are interested in pursuing.

Attendance, Cancellation and Refund Policy

I, the student, understand the Attendance Policy. *

I, the student, understand. *

I, the student, acknowledge. *

I, the student, accept this contract. *