Casa Loma College

Online App - MRI Post Primary Certification


CASA LOMA COLLEGE - Online Application for Admissions
6725 Kester Ave., Van Nuys, CA. 91405
Phone: 818-785-2726 / Fax: 818-785-2191
https://www.casalomacollege.edu
Your responses will be kept private and secure. (Personal information should match government issued ID) There is a non-refundable processing fee of $100.
Program of Interest


Personal Information
Social Security Number:

 Date of Birth:
Legal Last Name:
First:
MI:
Home Address:
City:
State:
Zip code:
Primary Phone:
Secondary Phone:
 
Do you have a different Mailing Address?
Mailing Address:
City:
State:
Zip code:
Email Address:
Sex Assigned at Birth:

Are you 18 years of age or older?

Parent/Guardian Last Name:
First:
MI:

Parent/Guardian Address:

City:
State:
Zip code:

Parent/Guardian Phone:


Have you ever been adjudicated guilty or convicted of a misdemeanor or felony?
Have you ever been convicted of any drug related offense?
Citizenship


Demogrpahics
Are you Hispanic or Latino?

Regardless of your answer to the prior question, please indicate how you identify yourself. (Select one or more)


Previous Education
High School:
State:
Graduated?
Mo/Yr:

College/s Attended:
State:
Graduated?
Mo/Yr:

College/s Attended:
State:
Graduated?
Mo/Yr:

Are you currently taking any college coursework at a college?
Course Name/s:


Financial Aid
Will you be a candidate for financial aid?
Have you received financial aid from an institution before?
School Name


City


State



I hereby certify that the answers and other information on this application are true and correct and that I understand any misrepresentation or falsifying of facts on my part make me ineligible for enrollment into Casa Loma College. I also understand that if upon my enrollment, false information was deemed to have been provided; I will be terminated from the college.

 

For Casa Loma College Use Only
Date:

Program:

Anticipated Class ID:

Admissions Rep:

Dir. of Admission Approval:

Processing Fee Received:
Yes ¨ No ¨
Date:Received By:
 

Leave this empty:

Signature arrow sign here


Signature Certificate
Document name: Online App - MRI Post Primary Certification
lock iconUnique Document ID: 3f040fed5c6e71b586a64bae71fff0c8e8f06d10
TimestampAudit
January 14, 2019 7:53 am PDTOnline App - MRI Post Primary Certification Uploaded by James Dugan - support@casalomacollege.edu IP 45.31.0.252