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Location of Interest:

Program of Interest:

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:

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:

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.

— Rob Russell – HVAC Technician

Laurus Technical Institute