Public enrollment

Enrollment Application

Provide the requested information to begin AimHigh’s admissions and eligibility-review process.

Before you begin

Submit one complete application.

Review each response for accuracy before submitting. AimHigh will use the information provided to continue the admissions and eligibility-review process.

Scroll Down to Complete Your Enrollment Application

Applications are accepted year-round. Approved applicants will be assigned to a case manager for assessment of financial supportive services. Financial supportive services are contingent upon active participation in selected online Certification Training program.
Please allow 10-14 business days for application processing.

How did you hear about us?

Name

First

Middle

Last

Gender

Male
Female

Phone Number

Date of Birth

SSN#

Address Line 1

Address Line 2

City

State

Zip Code

Country

Do you have a valid driver's license or photo ID?

Ethnicity / Race

Primary Language

Secondary Language

Name of High School Attended

Date of Last Year in High School

Year of High School graduation.

Highest Education Level Completed

Employment Status

Name of Previous Employer

Job Title

Start date of previous employment

End date of previous employment

Last hourly rate of pay

Reason for leaving

Do you have any work skills or strength?

Have you ever been convicted or have a pending sexual assault offense?

Are there any personal barriers which make it difficult to get or keep a job?

Are there any transportation barriers which make it difficult to get or keep a job?

Are there any family barriers which make it difficult to get or keep a job?

Please select an industry certification training course.

Certified Medical Billing and Coding (CBCS)
Certified Medical Administrative Assistant (CMAA)
Certified Pharmacy Technician (CPhT)
Certified EKG Technician (CET)
Certified Heating, Ventilation & Air Conditioning Technician & Dispatcher (HVAC)
Certified Residential Building Code Inspections (IRC)

Are you participating with a public or private employment training agency?

Are you registered with a workforce center/commission?

Are you actively receiving SNAP services?

Are you a dislocated worker?

1. Are you currently unemployed?

2. Do you need weekly childcare assistance, during the set-aside time for online learning?

3a. Do you have access to a computer?

3b. Do you have Internet Access?

4a. Monthly Household Income

4a. Source of Monthly Household Income

4b. Additional Monthly Household Income

4b. Source of Additional Monthly Household Income

4c. Additional Monthly Household Income

4c. Source of Additional Monthly Household Income

5. Does your monthly income exceed the federal poverty guidelines for the family size?

See Chart (Click to see)

6. Monthly Household Living Expenses

7. Does your monthly Household income exceed the monthly living expenses?

8a. What is your Monthly Water Expense?

Please provide a copy of your most recent Water Bill?

8b. What is your Monthly Electric Expense?

Please provide a copy of your most recent Electric Bill?

9. Are you currently behind on rent payments?

Consent for Release of Personal Records by Executive Agencies

I Accept (To Whom It May Concern: I have sought participation and assistance from AimHigh Education Technologies on a matter that may require the release of information maintained by your agency, and which may be prohibited from dissemination under the Privacy Act of 1974. I hereby authorize you to release all relevant portions of my records or to discuss information with AimHigh Education Technologies, or any member of it’s staff until the matter is resolved.)

Authorization

I certify under penalty of perjury that the above information is true and correct to the best of my knowledge.

Date

Participant Name

Participant Signature

Clear Signature

Case Management Only

Did the student participant successfully completed training course?

Did the student participant earn an industry certification?

Is the student participant employed with industry certification?

Are we providing job placement services with the student participants?

Is the student earning a second certification?

Which certification did the student earn?

HVAC Technician & Dispatcher
Medical Coding & Billing
Medical Administrative Assistant
Residential Building Code Inspections
Solar PV Installer Technician

Name of Case Manager: