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GENERAL INFORMATION

First Name:	Last Name:	Middle Name:
Street Address:	City:	State:
Zip:
Work Phone:	Home Phone:	Cell Phone:
Date of Birth:	Email Address:
Are you a U.S. citizen? Yes No	If not, list country of citizenship:
Alien Registration Number:	Visa Status:
What prompted you to visit this site?

EDUCATION

Name of High School:	Did you graduate? Yes No	If yes, enter graduation date:
Do you have a GED? Yes No	If yes, enter date completed:
Please list any postsecondary education, including vocational schools, technical schools, colleges or universities, that you have attended or are currently attending.
School Name:	From:	To:
City:	State:	Certificates or Degrees Earned:
School Name:	From:	To:
City:	State:	Certificates or Degrees Earned:

EMPLOYMENT HISTORY

Current Employer:	Position:	Duties:
From:	To:

CERTIFICATION AND AGREEMENT Have you ever been diagnosed with or do you possess any physical or mental impairment which may affect your ability to practice safely as a health care practitioner? Yes No If yes, please explain:

To the best of my knowledge, all information on this application is complete and accurate. I understand that by providing false or incomplete information, I may be ineligible for admission to Laurus Technical Institute. Moreover, I understand that discovery of false information or omission of information could result in dismissal from the school.

If applicable, I certify that I have registered (or will register) for selective services with the U.S. Armed Forces.

E-signature:		Date:

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What Graduates Are Saying:

Amanda Ford

Medical Assistant

In 2004, Ms. Ford found her passion and love for helping others. She decided to attend Everest Institute to obtain a diploma as a Patient Care Technician. When her father was involved in an auto accident that left him unable to care for himself, she stopped attending school. Her father spent a year in Shepherd Center. Ms. Ford would often volunteer to take care of the other patients, allowing the medical assistants to take a break.

In March, 2010, Ms. Ford decided to further her education in the medical assisting field. When Ms. Ford began school, the trials of life were already in full swing. She was almost homeless, no electricity at home, and the kids were misbehaving. In spite of those obstacles, she continued coming to school. Ms. Ford maintained a B average even though she could only study at school. Ms. Ford states, "I pushed past the problems and trails and continued forward." She said, "If it wasn't for Ms. Hall and Joslyn Henderson, my Admissions Rep, I would have quit school." Their listening ears, support and words of encouragement helped Ms. Ford make it through.

Today, Ms. Ford is thankful for her trials and problems. "I am not the same person I was when I started school. I am a stronger woman due to the trials and problems."

Rob Russell

HVAC Technician

Coming to Laurus was one of the wisest decisions I have made. I was a bit apprehensive about attending because I have been to other technical schools that were not as they advertised.

Here at Laurus, we immediately dove right into learning about the refrigeration cycle, EPA laws and how to use tools. The instructors are knowledgeable on the latest HVAC standards and equipment.

While at Laurus, I learned how to install heat pumps, gas furnaces and air handlers. I became an EPA certified technician within 4 months. Laurus helped me to prepare for interviews and with resume preparation and assisted me in finding employment.

I am proud to be a Laurus Technical Institute alumni, and I recommend anyone who is serious about a career in HVAC to attend Laurus and be on their career path in less than a year.

Jonathan Bell

HVAC Technician

My time at Laurus Technical Institute was a fun educational experience. In the past seven months, I have had a lot of things to learn that did not come easy to me, but with the help of the teachers, I was able to learn more than I ever imagined. The teaching environment, along with real time labs, makes Laurus Technical outstanding (they even provide transportation).

The main reason for me attending Laurus Technical was to learn about HVAC, but I have learned so much more (there is no limit in this field).

I would recommend Laurus Technical Institute to anyone wishing to explore this field.

Laurus Technical Institute

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