Apply Online

To best serve you during your visit, we ask that you answer the questions on this form as fully as you can. All information will be held in strict confidence and will be used to determine your aptitude for any of our career focused programs. Great Lakes Institute of Technology does not discriminate against any person because of race, color, religion, sex, disabilities, age, national origin, or ancestry regarding admission to programs.

Name(Required)

First Middle Last

Maiden Name

Phone

Date of Birth

Gender

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Driver's License #

Driver's License State

Hispanic or Latino

Ethnicity

U.S. Veteran

Citizenship

Emergency Contact

Name

Relationship

Phone

Background

Have you ever been convicted or pleaded guilty to a crime?

If yes, please explain.

Program of Interest

Education Information

HIgh School Name

Year Graduated

Address

City State / Province / Region

GED - Year Completed

State where completed

Disclaimer

If you opted-in to receive SMS/Text messages on your cell phone, it will only be used to send you communication pertaining to your application/enrollment. Please be aware your cell phone carrier may charge a fee for delivery of messages based on your current calling plan. Your number will not be given to any third party. You may opt-out in writing at any time.

Class sizes are limited to a maximum number of students per program and will be closed to enrollment when that number is reached. Enrollment is granted on a first-come first-serve bases only to registered applicants who have completed all admission requirements. Applicants who have not become enrolled in a class that has been closed have the option to register for a future class.

By signing this application, I authorize investigation of all statements contained in this application. I also authorize the school to review my financial aid history. I understand that misrepresentation or omission of facts called for is cause for rejection of admission, or dismissal, if enrolled.