New Application for Admission

General Information

First Name

Middle Name

Last Name

Citizenship

Race

American Indian or Alaskan Native

Asian

African American

White

Hispanic

Hawaiian or Pacific Islander

Gender

Mailing Address

City

State/Province

Zip/Postcode

Cell Phone

Home Phone

Email

Birth Date

Social Security Number

Start Term

Are you or have you been a member of the U.S. Military

Yes No Not Selected

Which Branch of The Military?

Are there any special accommodations/circumstances you would like us to be aware of?

Signature Date

How did you hear about the Industrial Arts Institute?

Emergency Contact Information

Contact Name

Relationship

Home Phone

Work Phone

Cell Phone

Disability

Yes No

Disability Description

Learning Difficulties

Yes No

Learning Difficulties Description

Personal Protection Equipment

Welding Jacket Sizing

Welding Gloves Sizing

(Basic Welding Only) I will provide my own required PPE (welding helmet, gloves & jacket.)

Yes No Not Selected

This information on this application is accurate. I understand that providing false information could lead to disciplinary action, including dismissal. Upon submission of this application, I give permission for IAI to correspond with me via phone, USPS mail, email, and text messaging.