The Divers Admissions Process – Tours, Application Process and Financial Aid for Divers Academy

Commercial Diving Course Enrollment Application

Page 1 of 2 / * Required Field

I agree to pay the Application and Registration fee of $125. I also understand the fee is non-refundable, unless rejected.

* Payment Method: My Check / Money Order is attached Visa Mastercard

Card #: Name of Cardholder:

Exp. Date (m/yyyy): /

Personal Information

* Last Name: * First Name:

SS #: * Email:

Date of Birth: / / (mm/dd/yyyy) Age:

Sex: Male Female Marital Status: Single Married

* Address: * City:

* State: * Zip Code:

* Country: Country of Birth:

Are you a US citizen: Yes No

If NO, Alien Registration No: Exp: / / (mm/dd/yyyy)

Country of Citizenship:

* Daytime Phone: . . Evening Phone: . .

Education and Background

High School: Graduated? Yes No

City: State:

General Educational Development (GED): Yes No

State: Test Date: / /

College/Trade School: Degree/Courses:

Have you ever applied for Student Loans or Grants? Yes No

If yes, are your loan payments current? Yes No

Military Background

Branch/Nation Served: G.I.Bill? Yes No

Dates of Service: / / to / /

Work History

Present Occupation:

Dates of Employment: / / to / /

Phone Number: . .

Employer Name: Address:

City: State: Zip Code:

Emergency Information

Name (Person to Notify): Relationship:

Address: City:

State: Zip Code:

Phone Number: . .