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Enrollment Application

  • To determine whether you can gain from our course of study, we ask that you answer the questions on this form. Please answer all questions as fully as you can. All information will be held in strict confidence and will be used to determine your aptitude for a technology career. Upon graduation, information on this form may assist with placement.
  • Admissions requirements/criteria are listed in the School Catalog.
  • EIT does not discriminate against any person because of race, color, religion, sex, disabilities, age, national origin, or ancestry regarding admission to programs or placement activities.

Personal Information
*First Name *Last Name
Middle Initial Maiden Name
*Address *City
*State Zipcode
*Home Phone Cell Phone
Work Phone
May we contact you at work? May we text your cell phone?
*Email Address Date of Birth
Driver's License # Driver's License State
Gender
Hispanic or Latino? Ethnic
Veteran? Citizenship
Alt. Contact Name Relationship
Alt. Phone

Background and Health

Have you ever been convicted or pleaded guilty to a crime?
If yes, please explain:
Condition of Health: Please explain any special health requirements or any physical problems?
List known allergies.

Program of Interest

I am applying for:
When would you like to begin?

Education Information

GED - Year Completed State Where Completed
High School Diploma - Year Graduated:
High School Name City / State

Beginning immediately after high school, list all other training you have started and/or completed, including college, trade, or business schools:

School NameCity, StateProgram of Study, type of degree earned:
Years AttendedDid You Graduate
Yes?
School NameCity, StateProgram of Study, type of degree earned:
Years AttendedDid You Graduate
Yes?
School NameCity, StateProgram of Study, type of degree earned:
Years AttendedDid You Graduate
Yes?

Employment History
Please list job experience, starting with the most recent job first.
Employer Name & AddressPosition HeldFrom (date)To (date)
1.
2.
3.

References
NameAddressCity, State
Phone #RelationshipZip Code
NameAddressCity, State
Phone #RelationshipZip Code
NameAddressCity, State
Phone #RelationshipZip Code

Disclaimer
As part of the admission requirements, there is a $25.00 Application Fee due when you apply.

Applicants must complete a High School Transcript and / or a GED Transcript release form.

*If you opted-in to receive SMS / Text messages on your cell phone, it will only be used to send you communication pertaining to your enrollment. Please be aware your cell phone carrier may charge a fee for delivery of messages based on your current calling plan. Your number will not be given to any third party. You may opt-out in writing at any time.

Class sizes are limited to a maximum number of students per program and will be closed to enrollment when that number is reached. Enrollment is granted on a first-come first-serve bases only to registered applicants who have completed all admission requirements. Applicants who have not become enrolled in a class that has been closed have the option to register for a future class.

I authorize investigation of all statements contained in this application. I understand that misrepresentation or omission of facts called for is cause for rejection of this application or dismissal, if enrolled.


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