Student Information Sheet
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1STUDENT INFORMATION SHEET
NAME: ___________________________________________________________________________________
LAST
FIRST
M.I.
ADDRESS: _______________________________________________________________________________
STREET
CITY
STATE
ZIP
DATE OF BIRTH: ____________________________
_____________________________
PHONE (HOME):
E-MAIL ADDRESS: __________________________________
______________________________
CELL:
EMERGENCY CONTACT: ____________________________ ADDRESS:__________________________
PH. # – CELL:____________________ HOME: ____________________ WORK: ___________________
Please list any health issues that may hinder your progress in this course? __________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
EDUCATION: Have you attended any other training that would give you credit for RV Training?
High School/College/Tech School
City & State
Date Graduated
Program
Degree/Diploma/Certificate
_____________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
(Please use additional page for education if needed)
JOB EXPERIENCE:
Employer
Address & Phone
Dates
Position/Duties
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
(please use add’l page for job experience (if needed)
_________________________________________________________________
How did you hear about us?
( ) Radio ( ) TV ( ) Handout ( ) Internet ( ) RV show ( ) Graduate ( ) Dealer ( ) Other
RV REPAIR EXPERIENCE
________________________________________________________________________________________
________________________________________________________________________________________
_____________________________________
Why are you interested in becoming an RV Service Technician?
________________________________________________________________________________________
________________________________________________________________________________________
__________________________________________________
Do you own an RV? ( ) No ( ) Yes What kind?
________
________
_________
Class you would like to attend? __________ Winter
Spring
Summer
Fall
I HEREBY ATTEST THAT THE ABOVE INFORMATION IS TRUE AND CORRECT. ANY INFORMATION THAT IS FALSE COULD RESULT IN
DISMISSAL FROM THIS PROGRAM.
SIGNED:__________________________________________________________________________________DATE:___________________________________
2016
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