Eligibility Application

This is the last step in our selection process. Please fill out this form accurately and honestly.

Student Information

Portrait Photo(s) *

Include two photos of yourself. Say Cheese!

First Name *

Last Name *

Address *

City *

State *

Postal code

Country

Email *

Phone *

Date of birth *

Social Security or National Insurance #

Age *

Disability Status

YES

Ethnicity

Hispanic or Latino, for a person of Mexican, Puerto Rican, Cuban, South or Central American, or other Spanish culture of origin, regardless of race

Not-Hispanic or not-Latino

Race

American Indian or Alaska Native. A person having origins in any of the original peoples of North and South America (including Central America).

Asian. A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent.

Black or African-American. A person having origins in any of the black racial groups of Africa.

Native Hawaiian or Other Pacific Islander. A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands

White. A person having origins in any of the original peoples of Europe, the Middle East, or North Africa

Personal History

Are you an 'only' child? *

YES

Are your parents divorced? *

YES

Were you adopted?

YES

Short Biography *

Social Development *

Emotional Development *

Psychological Development *

Physical Development *

Patient Health Records

Please attach any patient health records (Social, Emotional, Psychological, Physical)

Parent Name / Financial Guarantor

Parent Name / Financial Guarantor *

Parent/ Financial Guarantor Date of Birth

Relationship to Student

Occupation / Company of Parent/ Financial Guarantor

Home Address of Parent/ Financial Guarantor

City of Parent / Financial Guarantor

State of Parent / Financial Guarantor

ZIP / Postal Code

Country of Parent/ Financial Guarantor

Cell Phone of Parent/ Financial Guarantor *

Home Phone of Parent/ Financial Guarantor

Work Phone of Parent/ Financial Guarantor

Email of Parent/ Financial Guarantor *

Other Parent Name

Other Parent Full Name

Other Parent Date of Birth

Other Parent Relationship to Student

Other Parent Occupation/Company

Other Parent Home Address

Other Parent City

Other Parent State / Province / Region

Other Parent ZIP/ Postal Code

Other Parent Cell Phone *

Other Parent Home Phone

Other Parent Work Phone

Other Parent Email *

Other Emergency Contact

Emergency Contact Relationship to Student

Emergency Contact Full Name

Emergency Contact Occupation/Company

Emergency Contact Home Address

Emergency Contact City

Emergency Contact State

Emergency Contact ZIP / Postal Code

Emergency Contact Cell Phone

Emergency Contact Home Phone

Emergency Contact Work Phone

Emergency Contact Email

Personal Medical Information

Weight

Height

Blood Pressure

Blood Type

Please list all current medications

Please list all known allergies

Medical Contact Information

Physician Name

Physician Cell Phone

Dentist Name

Dentist Cell Phone

Insurance Coverage Information

Do you have medical insurance?

YES

Do you have dental insurance?

YES

Medical Insurance Information

Medical Insurance:

Medical Insurance Address

City Medical Insurance

Medical Insurance State

Medical Insurance Zip Code

Medical Insurance Country

Policy #

Group #

Phone Number of Insurance Company

Scan / Photo / Copy of Medical Insurance Card

Please scan / photo / copy the front and back of your medical insurance card and upload both files here.

Dental Insurance Information

Dental Insurance

Dental Insurance Street Address

Dental Insurance City

Dental Insurance State

Dental Insurance Zip Code

Dental Insurance Country

Dental Insurance Policy #

Dental Insurance Group #

Dental Insurance Phone #

Scan / Photo / Copy of Dental Insurance Card

Please scan / photo / copy the front and back of your dental insurance card and upload both files here.

Education

Highest grade completed

GPA

What's your educational goals?

Do you have any learning or reading disabilities?

YES

Please explain

Employment

How many jobs have you had in the last 3 years?

3 or more

None

Job #1

Job #1 Phone #

Position

Name of supervisor Job #1

Reason For Leaving

Start Date

End Date

Hourly Pay

Job #2 Company Name

Job #2 Position

Job #2 Phone Number

Start Date of Job #2

End Date of Job #2

Hourly Pay of Job #2

Reason for Leaving Job #2

Job #2 Name of supervisor

Job #3 Company Name

Job #3 Phone Number

Job #3 Hourly Pay

Job #3 Position

Job #3 Name of supervisor

Start Date Job #3

End Date Job #3

Reason For Leaving Job #3

Finance

What is your credit score?

What is your total debt amount? *

Do you have any credit cards?

How many credit cards do you have?

Do you have any debt?

Do you have a bank account?

How many bank accounts do you have?

Bank #1 Name of Bank

Total current balance of bank #1

Bank #2 Name Of Bank

Total current balance of Bank Account #2

Bank #3 Name of Bank

Total Current Balance of Bank #3

Transportation

Do you know how to ride a scooter / moped?

Do you have a drivers license?

Do you know how to ride a bicycle?

Do you have a car?

Is the title of the car in your name?

What kind of car is it?

Do you have any accidents? If so how many?

Do you have any tickets? If So how many?

Essay: Why do you want to attend Forte Strong? *

Please be as open and honest as possible. This is your chance to speak from the heart and express how you feel. You might want to talk about where you find yourself today, what personal choices may have contributed to your current situation and what you would like to change about it. What you talk about is entirely up to you. Please proof read your work and ensure grammar and punctuation is correct.

Acknowledgement* By signing below, the Applicant and Parent/Guardian certify that the information in this application is true and accurate to the best of their knowledge. Student and Parent/Guardian understand that if the Applicant is accepted for enrollment and information in this application is determined to be false, inaccurate, or incomplete, the Applicant may be removed from Forte Strong without a refund. Applicant and Parent/Guardian understand that the Applicant can not be guaranteed a enrollment seat without submitting the non-refundable enrollment deposit first. *

I agree to these terms

Student or Parent Signature *

Clear