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  School Application - If you would like to apply to any of LaSalle's programs please complete the form below and choose submit.




What program are you applying for?
First Name:          
MI:      
Last Name:      
Company:      
Title:      
Address:  
City: State: Zip:  
Email:        
Gender:      
U.S. Citizen:      
If No, Name of Country:      
Home Phone:      
Office Phone:      
Date of Birth:      
Emergency Contact: Phone:
Relationship: Address:
 

Race/National Origin (Please check all that apply)


White Black or African American    
Hispanic Native Hawaiian or Pacific Islander Asian
American Indian Alaskan Native    

Educational Background


I recieved / will receive my standard high school diploma from:
High School Name: City:
State:
Graduation Date:
I received a General Education Development (GED) from:
State: Date:
I have not received a standard high school diploma, GED certificate, or equivalent.
 

Below please list all colleges, universities, technical schools, etc. that you have
attended or are currently attending.
 

Briefly describe your personal and / or work experience with computers.


 


 

I certify that this information is complete and accurate. I agree to abide by all rules and regulations of LaSalle Computer Learning Center. I understand that making false or fraudulent statements within this application or residency statement will result in disciplinary action, denial of admission, and invalidation of credits or diplomas earned. I will notify the staff if any of my information changes while attending LaSalle Computer Learning Center. By typing your name below you are in agreement with the statement below and that your typed name will be considered your authentic signature.

Type your full name as your authentic signature that all information is accurate and correct in the box below. Your typed name will be considered your signature.

 



 
 

 
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