Application

If you see this skip this input box.

*Student ID (LoLA ID)

*Last Name

*First Name

Middle Name

*Home Phone Number

*Cell Phone Number

*E-Mail Address

*Driver's License Number

*Driver's License State

*Date of Birth (Month/Date/Year)

Address

City

State

Zip Code

Expected Semester of Enrollment

Programs

*Which Program Interests You?

Automotive Technology (Associate of Applied Science)Collision Repair TechnologyDiesel Heavy Truck Technology (Associate of Applied Science)

Convicted of a crime

Have you ever been convicted of a crime other than a minor traffic violation?

YesNo

If yes, what crime and when?

Diploma

Do you have a high school diploma or equivalency?

YesNo

If Yes Date Obtained

Other Automotive Technology program

Have you previously been enrolled in an Automotive technology program at any other institution?

YesNo

If yes, what school?

If yes, why did you leave that program?

I would like to apply for admission to the Automotive Technology Program. I understand that any attempt on my part to falsify or exclude information is cause for disqualification of my application and/or dismissal from the program. I hereby certify that all information presented is true to the best of my knowledge.

I agree.

*Your Signature (first and last name)