(* Required
Field)
GENERAL
INFORMATION
* Last Name:
* First
Name:
Middle Initial:
* Address:
* City:
* State/Province:
Country:
* Postal
Code:
* Email:
* Confirm
E-mail :
* Home Telephone
Number:
-
-
Business/Cell
phone Numbers: (optional)
-
-
* What is your age?
Choose One
18
19
20
21
22
23-25
26-30
31-40
41-50
51-60
61-70
71 or older
Unspecified
* Gender:
Choose One
Male
Female
Unspecified
EDUCATIONAL
BACKGROUND
* What
is your highest level of Education?
Choose One
High School - Diploma/GED
High School - Not
finished
College - Under 2 Years
College - 2 Year Degree
College - Less Than
4 Years
College - 4 Year Degree
College - Master's
Degree
College - Doctorate
Degree
Have
you applied to LAVI before?
If yes, for which year?
WHICH
PROGRAMS INTEREST YOU
Massage
Therapy
150 Hrs.,
300 Hrs.,
500 Hrs.,
800 Hrs.
Physical
Therapy Aide
300 Hrs.
Pharmacy
Technician
Medical
Coding and Billing
Medical
Assistant
Phlebotomy
Certified
Nurse's Assistant
Home
Health Aide
English
as a Second Language (ESL)
PLEASE
CHECK DESIRED CLASS SCHEDULE
Morning
Evening
Weekends
Start
Dates: (view
program calendar on web)
Month
Jan
Feb
Mar
Apr
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
FINANCIAL
PLANNING
* Will
you be seeking Financial assistance?
* Are you
a U.S. Citizen?
* Are you
a U.S. Resident?
WHY
YOU CHOSE L A VOCATIONAL INSTITUTE
I
have a friend who attended your school
I
hear you have a good reputation
Your
training is recognized by other States
Other
HOW
DID YOU HEAR ABOUT L A VOCATIONAL INSTITUTE
Search
Engine
Newspaper
Natural
Healers
Radio
/TV
Other