Register for classes – Millennium Trade Academy

First Name *

Last Name *

Select course of study *

Desired program schedule *

Date

Registration fee is non-refundable

Address

City

State/Province

Zip/Postal

Country

Primary Phone

Secondary Phone

Email *

Driver License No

Date of Birth

State

Place of Birth

Gender Gender

Martial Status

Dropdown Dropdown

Are you a veteran?

Yes

If yes, Service # & Military Branch

Are you employed?

Yes

Place of Employment & Work Shift

Please List any Physical disabilities the school should be aware of / Are you currently taking any prescribed medications (If so, please list):

Admission Information

Education

High School Graduate

GED Certificate

Name of High School or Program:

Month and Year of Completion:

Desired Program Schedule:

Part Time Day (26 hrs/week) Tuesday – Friday: 9:00AM-2:00PM Saturday : 8:00AM-2:00PM

Part time Evening (23 hrs/week) Tuesday – Friday: 5:45PM-10:00PM Saturday : 8:00AM-2:00PM

Full Time Day (36 hrs/week)Tuesday – Friday: 9:00AM-4:30PM Saturday : 8:00AM-2:00PM

Additional Information

Have you ever been found guilty or convicted of a felony?

Yes

Pending Felony Charge(s)

If yes, please explain the nature of the crime(s), the county(ies) and state(s) in which the crime(s) occurred:

How did you hear about Millennium Trade Academy? Who referred you?

Please explain why you are interested in starting one of our programs.

Have you ever applied for Financial Aid?

Yes

Emergency Contacts

Name

Phone Number

Address

City

State/Province

Zip/Postal

Country

Name

Phone Number

Address

City

State/Province

Zip/Postal

Country

I certify the information that I have given is true and correct. I have also received or had access to all pre-enrollment information regarding the institution, the physical demands and safety requirements for the profession, state licensing requirements, orientation and a copy of the school handbook.

Signature

Clear

Date

Signature of Parent or Guardian (If applicant is under 18 years old)

Clear

Date

If you are human, leave this field blank.

New Class Start Every First Tuesday of each Month

Register Now

Admission Information

Additional Information

Emergency Contacts

Need help? Call our award-winning support team at (336) 542-9495

OFFICE HOURS OF OPERATIONS

CLINIC FLOOR HOURS DAYS

LINKS