TASA School and Student Forms — Enrollment Application

1. Program Information

Program Name

Major Appliance Repair Technician — 3-Week Intensive

Desired Start Date

How did you hear about TASA?

Referral Name (if applicable)

2. Applicant Information

First Name

Middle Name

Last Name

Date of Birth

Social Security Number (last 4)

Email Address

Phone Number

3. Mailing Address

Street Address

City

State

ZIP Code

4. Emergency Contact

Full Name

Relationship

Phone Number

Email

5. Education & Employment Background

Highest Education Level Completed

☐ High school ☐ GED/equivalency ☐ College ☐ Equivalent secondary education

Currently Employed?

☐ Yes ☐ No

School / Institution, Location, Graduation or Completion Date

Education Evidence Submitted

☐ Diploma ☐ High-school transcript ☐ GED certificate ☐ College transcript/diploma ☐ English translation ☐ Other: __________

If documentation is unavailable, select the applicable pathway and attach required evidence

☐ Signed and notarized attestation + written evidence records could not be obtained
☐ Age 18+ ability-to-benefit test result
☐ High-school student: principal’s written approval attached (if applicable)

Current Employer & Occupation (if applicable)

Previous Technical Training or Trade Experience

6. Additional Questions

Age on the first day of class

__________ years. Applicants must be at least 18 for this program.

Do you have any physical limitations that may affect your participation in hands-on training?

☐ No ☐ Yes — describe any accommodation or safety support requested: _________________________________

Have you ever been convicted of a felony? (A "yes" answer does not automatically disqualify admission.)

☐ No ☐ Yes — explanation, if you choose: __________________________________________

What are your goals after completing the program?

7. Tuition Acknowledgment

I understand that by submitting this application, I am not obligated to enroll, nor is TASA obligated to accept me. I understand that this application is subject to review and that I may be contacted for an interview. I certify that all information provided is true and accurate to the best of my knowledge. I understand that providing false information may result in denial of admission or dismissal from the program. I understand that the school will administer its published admission requirements as written and retain the education evidence required for my admission pathway. I understand that this application is not an enrollment agreement and does not itself create a tuition obligation.