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Student Information
Name
*
First
Last
Social Security Number (last 4 only)
*
XXX-XX-
Please enter a number less than or equal to
9999
.
Date of Birth
*
Date Format: MM slash DD slash YYYY
CA DL#
State License
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Email
*
Home Phone
*
Mobile Phone
Employers Information "Statement of Fact"
Business Name
Business Phone
Business Fax
Business Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Course Information
Class Schedule: Monday, Tuesday and Wednesday 6:00PM to 10:00PM
Course Name
*
Inspector Licensing - ($1,600.00)
Repair Technician Licensing - ($1,200.00)
Inspector Level 2 - ($600)
Repair Technician Update Course - ($225.00)
Brake & Lamp Preparation Course - ($600.00)
AC Diagnostics, Repair & Certification - ($225.00)
Electrical Diagnostic Course - ($225.00)
Level I Citation 8hrs - ($125.00)
Level II Citation 16hrs - ($600.00)
Level III Citation 72hrs - ($1000.00)
Scheduled Start Date
*
Date Format: MM slash DD slash YYYY
Scheduled Completion Date
*
Date Format: MM slash DD slash YYYY
Payment Options
*
All Course Tuition Fees include a $75 registration deposit that is non-refundable. Please select whether you would like to pay just the deposit at this time or the full amount.
Deposit Only
Full Amount
Inspector Licensing Tuition
*
*Total Registration, Books, Materials & Supplies included in tuition
Price:
$1,600.00
Repair Technician Licensing Tuition
*
*Total Registration, Books, Materials & Supplies included in tuition
Price:
$1,200.00
Inspector Level 2
*
*Total Registration, Books, Materials & Supplies included in tuition
Price:
$600.00
Repair Technician Update Course Tuition
*
*Total Registration, Books, Materials & Supplies included in tuition
Price:
$225.00
Brake & Lamp Preparation Course Tuition
*
*Total Registration, Books, Materials & Supplies included in tuition
Price:
$600.00
AC Diagnostics, Repair & Certification Tuition
*
*Total Registration, Books, Materials & Supplies included in tuition
Price:
$225.00
Electrical Diagnostic Course
*
*Total Registration, Books, Materials & Supplies included in tuition
Price:
$225.00
Level I Citation Tuition
Price:
$125.00
*Total Registration, Books, Materials & Supplies included in tuition
Level II Citation Tuition
*
Price:
$600.00
*Total Registration, Books, Materials & Supplies included in tuition
Level III Citation Tuition
*
Price:
$1,000.00
*Total Registration, Books, Materials & Supplies included in tuition
Registration Deposit
*
(Non Refundable)
Price:
$75.00
Total
$0.00
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