Program Application

Contact Information - Step 2 of 5

Email*

Address*

Address Line 2

City*

State/Province/Region*

Postal Code/Zip*

Country*

Phone*

Is this a mobile phone?* Yes No

Do we have permission to text you at this number?* Yes No

Alternate Phone

Is this a mobile phone? Yes No

Do we have permission to text you at this number? Yes No

Race/Gender/Ethnicity Information - Step 3 of 5

Gender*--None--Female Male

Race*--None--Yes, Spanish, Hispanic or Latino No, not Spanish, Hispanic or Latino

Ethnicity*--None--American Indian or Alaska Native Asian Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander White Two or More Unknown Choose Not to Answer

Education Information - Step 4 of 5

Year of Highschool Graduation*

Name of Highschool or Equivalent*

Program Information - Step 5 of 5

Total program cost includes contact hours, registration fee, required reading materials and supplies, activity and lab fees, and, a Short Term Diamond level membership for the student to Life Time Fitness for the duration of the program.

Please select the program you would like to apply for:*

Select program

Select program specialization

Preferred Start Date:* Select One

Please select the location you are interested in.* Select location

Please select scholarship you would like to apply for:*