ATI College

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You can either submit your information online or call us 800.516.1119 right now.

GENERAL INFORMATION:

Program of Interest

First Name

Last Name

Phone (Day)

Phone (Evening)

E-mail

Street Address

City

State

Zip

Country

PERSONAL INFORMATION:

Birth Date

/ / (MM/DD/YYYY)

Are you a US citizen?

Yes No

If no, what is current status?

Social Security Number

- - (optional)

License Number

(optional)

Gender

Male Female

SCHOOL INFORMATION:

High School Graduation/GED Year

(or expected year)

High School Name

High School City

High School State

Have you applied to ATI College before:

Yes No

If yes, for which year?

(YYYY)

Have you attended other college before?

Yes No

If yes, how long did you attend?

Less than 1 year
1-2 years
2-3 years
3-4 years

Degree Received?

Yes No

If yes, what degrees have you earned?

EMPLOYMENT INFORMATION:

Current Employer:

Position:

Number of hours you currently work per week:

METHOD OF PAYMENT:

Have you set money aside for your education?:

Yes No

Will you be seeking financial aid?

Yes No

Select One:

	I will pay for my entire term charges on or before registration.
	I will provide a letter from an authorized company or agency confirming that they will pay my entire charges each term.
	I will require financial aid to help pay my term charges.

OTHER:

Is English your primary language?

Yes No

Have you taken the TOEFL

Yes No

When is the best time to contact you?

How did you hear about ATI College?

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