Career Job Training Application

Contact Information

Permanent Address

Country

Street

City

Region

Postal Code

Mailing Address

Same as Permanent Address

Country

Street

City

Region

Postal Code

Email Address

Primary Phone

Is the above number your mobile number?

Yes

Do you consent to receive text messages from PHSC at this number? (data rates my apply)

Yes

Mobile Phone (Hidden)

Application Information

Start term

Area of Interest

By signing this application, I certify that the answers given herein are true and correct to the best of my knowledge. I agree that, if accepted, I will abide by all rules, regulations and policies of the College, now and hereafter adopted, as set forth in the District Board of Trustees Rules and as published in the College catalog. I understand that falsification of information in any admissions document is grounds for denial of admission and may result in dismissal from the College. I hereby give permission to PHSC to photograph me and publish such photos in any PHSC advertising media, including videotapes, slides, printed publications and any other media form, for all of the uses permitted by Florida Statute. I also agree to the release of any transcripts and/or test scores to be sent electronically to or from PHSC to other educational institutions upon request.

I agree to the above statement.

By signing this application, I certify that I understand and acknowledge that if the program for which I am applying results in licensure, the licensing requirements are only applicable to the state of Florida and may not be valid in other states or territories.

I agree to the above statement.

Electronic signature of person

Major (Hidden. Default = Continuing Education/Non-Credit)