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GENERAL INFORMATION

EDUCATION

I have graduated from
high school:
Yes No		 I am planning to graduate
from high school:
Yes No		 I have received a GED certificate:
Yes No		 I am expecting to receive a GED certificate:
Yes No
If Yes, Month/Year
/
MM/YYYY		 If Yes, Month/Year
/
MM/YYYY		 If Yes, Month/Year
/
MM/YYYY		 If Yes, Month/Year
/
MM/YYYY
Yes No
Yes No

Less than 1 year
1-2 years
2-3 years
3-4 years
Degree received? Yes No
Extracurricular Activities (such as community or school involvement):

EMPLOYMENT

Current Employer:

 Position:
Duties:
Indicate the number of hours you currently work per week:
Have you set money aside for your education? Yes No

PERSONAL

Date of Birth
/ /
MM/DD/YYYY
Gender:   Male      Female
Are you a U.S. citizen? Yes No
How did you hear about Fortis?
What are you hoping to achieve with your education from Fortis?
How quickly are you looking to enroll?
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