Application for Admission Please fill out completely. WHICH CAMPUS WOULD YOU LIKE TO ATTEND?Atlanta, GACharlotte, NCDallas, TXHouston, TXIndianapolis, INKansas City, MOLas Vegas, NVOrlando, FLPhiladelphia, PASan Francisco, CAVirginia Beach, VAWashington, D.C.FIRST NAMEMIDDLELAST NAMEAGEDATE OF BIRTHADDRESS (STREET)CITYSTATEALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYZIP CODEHOUSINGBoardOwnRentHOME PHONEWORK PHONEMARITAL STATUSDivorcedMarriedSingleWidowedDRIVER'S LICENSEYesNoOWN CAR Yes EMAIL ADDRESS CELL PHONEETHNICITYSurvey for US Department of EducationNonresident AlienHispanic/LatinoAmerican Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhiteTwo or More RacesUnknownGENDERFemaleMaleCITIZENSHIPU.S. CitizenNon-U.S. CitizenSPOUSE'S NAMESPOUSE'S OCCUPATIONCOMPANYPHONENEAREST RELATIVE'S NAMENEAREST RELATIVE'S OCCUPATIONCOMPANYPHONEHAVE ANY OF YOUR FRIENDS OR RELATIVES ATTENDED THIS SCHOOL?YesNoNAME OF FRIEND OR RELATIVE WHO ATTENDED THIS SCHOOL?HOW DID YOU LEARN ABOUT US?InternetFriendNewspaperBillboardTVTelemarketingRadioMailingOnline ChatCommunity EventOtherTRANSPORTATIONCarPublicRide ShareOtherAVAILABILITY DATEINTENDED PROGRAM OF STUDYHOBBIES & INTERESTSMilitary Service YOU MUST ANSWER EACH OF THE FOLLOWING QUESTIONS COMPLETELY. ARE YOU A VETERAN?YesNoREGISTERED FOR SELECTIVE SERVICES (males only)YesNoIS YOUR SPOUSE OR PARENT ON ACTIVE MILITARY DUTY OR A VETERAN? (You might be eligible for free tuition!)YesNoLevel of Education HIGH SCHOOL NAME OF SCHOOLCITYSTATEALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYFROM (Month, Year)TO (Month, Year)YRS COMPLETEDGRADE AVG.DEGREES TITLEGRADUATEDYesNoGEDMAJOR OR SUBJECTSLevel of Education COLLEGE / UNIVERSITY / OTHER NAME OF SCHOOLCITYSTATEALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYFROM (Month, Year)TO (Month, Year)YRS COMPLETEDGRADE AVG.DEGREES TITLEGRADUATEDYesNoGEDMAJOR OR SUBJECTSEmployment START WITH PRESENT OR MOST RECENT POSITION HELD INCLUDING MILITARY EXPERIENCE. FROM (Month, Year)COMPANY NAMEADDRESSCITYSTATEALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYZIP CODETO (Month, Year)POSITION, TITLE OR RATINGINDUSTRY OR PRODUCTSSUPERVISOR NAMESUPERVISOR TITLESUPERVISOR PHONEDUTIESFROM (Month, Year)COMPANY NAMEADDRESSCITYSTATEALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYZIP CODETO (Month, Year)POSITION, TITLE OR RATINGINDUSTRY OR PRODUCTSSUPERVISOR NAMESUPERVISOR TITLESUPERVISOR PHONEDUTIESFROM (Month, Year)COMPANY NAMEADDRESSCITYSTATEALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYZIP CODETO (Month, Year)POSITION, TITLE OR RATINGINDUSTRY OR PRODUCTSSUPERVISOR NAMESUPERVISOR TITLESUPERVISOR PHONEDUTIESReferences REFERENCEOCCUPATIONCOMPANYADDRESSPHONEREFERENCEOCCUPATIONCOMPANYADDRESSPHONEREFERENCEOCCUPATIONCOMPANYADDRESSPHONEAll of the above information is accurate and correct to the best of my knowledge. I hereby authorize the school or its agent to communicate with any person, credit reporting agency, firm or corporations, including my employer, in respect to my suitability to attend school. Further, by submitting this application, I give consent to Aviation Institute of Maintenance, and their agents, to contact me by email or telephone (both mobile and home, including pre-recorded and/or using auto-dialers) at the number I have provided in the form above to receive marketing information about Aviation Institute of Maintenance's programs, offers and general information about our school as part of our Privacy policy. I understand that my consent to receive SMS text messages is not required to get a quote or to purchase any products or services from Aviation Institute of Maintenance, or its affiliated schools or companies, and that I may instead reach Aviation Institute of Maintenance or its related entities by phone at 1-888-349-5387 to proceed without giving this consent. I agree to submit any claims arising out of my attendance or any aspect thereof, including disputes concerning alleged civil rights violations, to binding arbitration.Applicant Signature*Date*PhoneThis field is for validation purposes and should be left unchanged.