PDF Form

APPLICATION INFORMATION

Campus*

Program Applied for*

Preferred Schedule*

APPLICANT INFORMATION

First Name*

Last Name*

D.O.B*

Gender*

Social Security No.*

Street address*

City*

State*

Zip Code*

Home Phone

Cell Phone*

Email*

Are you a citizen of the United States?*

Yes

No

Are you*

Left handed

Right handed

Education*

High School

G.E.D

Homeschool

Diploma Year*

How did you hear about us?

If you were referred, by whom:

Are you a transfer from another school?*

Yes

No

Have you ever been convicted of a drug related charge?*

No

Yes

EMERGENCY CONTACT

First Name*

Last Name*

Relationship*

Phone Number*

Email*

APPLICATION CHECKLIST

To finalize your application, please submit or complete the following:

Download the Asher Institute of Hampton App on your phone or tablet
Completed Admissions Application form
Individual ID photo 2x2 or passport picture
$100.00 non-refundable application fee (expires after one year)
Copy of your high school diploma, high school transcripts or proof of G.E.D.
One form of identification including driver’s license, passport, voter registration card or birth certificate

By signing below, I verify that the information supplied on this application and in all related documents is truthful. I understand that any omissions or misrepresentations may result in my application being denied. I understand that my enrollment is contingent upon completion of my financial plan.

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.


Signature	Print Name	Date

Date*