Application - HVACTA

HVAC Technical Academy Enrollment Form

First Name

Middle Name

Last Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Primary Phone

Secondary Phone

Emergency Contact Name

Relationship

Emergency Contact Phone Number

Are you a US military veteran?

Yes

Are there any medical conditions which may impair your ability to perform efficiently and safely? ?

Yes

What is your Funding Source

Self-Pay

Career Source

Other

Enter your funding source

Friend or family member name please

Career Assistance & Follow-Up Consent

By submitting this form, I authorize 2nd Chance University, CareerSource Central Florida, and HVAC Technical Academy to assist with my career progression upon program completion. This may include help with career documents and presentation, and contacting potential employers on my behalf in written, digital, or phone formats. I also authorize these organizations to follow up with me and, where applicable, my current or future employer(s) for up to 24 months after program completion for gainful-employment tracking.

SMS / Text consent

I agree to receive text messages about my application, scheduling, and program updates.

Email Consent

I agree to receive email messages about my application, scheduling, and program updates.

Application Attestation & Program Terms Field

I certify that the information submitted is true and accurate. I agree that HVAC Technical Academy (or a representative of CareerSource Central Florida or 2nd Chance University) may contact me for additional information or clarification, and I agree to schedule an on-site interview prior to acceptance. I understand that submitting this application does not guarantee admission to the program.

Signature

Date / Time

HVAC Technical Academy Enrollment Form

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