The RefrigerationSchool, Inc.
Enrollment Application

Required fields indicated with a red *

Personal Information

First Name: *
Last Name: *
Address: *
City: *
State: *
Zip: *
Main Phone: *
Secondary Phone: *
Email: *
Are you in good health? *	Yes No
Are you a citizen of the United States? *	Yes No
Are you a convicted felon? *	Yes No
Are you married? *	Yes No
How did you hear about RSI: *

Education and Work Information
Check one that applies *	Diploma GED College Degree None
Name of High School *
City: *
State: *
Have you set aside the funds for your education? *	Yes No
Will your family assist you financially? *	Yes No
Class start date (MM/DD/YY): *
Class start time: *	AM PM NT
Course: *
Please tell us why you want to come to The Refrigeration School, Inc.: *

Reference Information (If you don't have a spouse, please type N/A)
Spouse Name: *
Phone Number: *
Employer: *
Employer Phone: *

Reference # 1
Name: *
Street Address: *
City: *
State: *
Zip: *
Phone Number: *
Relationship: *

Reference # 2
Name: *
Street Address: *
City: *
State: *
Zip: *
Phone Number: *
Relationship: *

Reference # 3
Name: *
Street Address: *
City: *
State: *
Zip: *
Phone Number: *
Relationship: *

Reference # 4
Name: *
Street Address: *
City: *
State: *
Zip: *
Phone Number: *
Relationship: *

---------FOR SCHOOL USE ONLY--------- I have personally reviewed this applicant and my recommendation is:__________________________ Representative: ___________________ Starting Date: ________ Day: ________ Evening: ________

The Refrigeration School, Inc. © 2003 - 2007
4210 East Washington St
Phoenix, AZ 85034
Phone:(602) 275-7133 Email: info@rsiaz.edu
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The RefrigerationSchool, Inc. Enrollment Application

The RefrigerationSchool, Inc.
Enrollment Application