Course Selection
Lodging Management (twice a week for 20 weeks)
Foodservice Management (once a week for 16 weeks)

Preferred Time and Location:
9:00 AM to Noon
6:30 - 9:30 PM

Norfolk
Portsmouth
Virginia Beach
Hampton
Newport News
Williamsburg

Are you working in the hospitality industry?
Yes
No

If yes, where?.

Please provide the following contact information:
Name

Street Address

Email Address

Apt

City

State

Zip

Daytime Phone

Home Phone

FAX


Social Security #:.


Gender:
Male
Female

Date of birth: -- mm/dd/yy


Legal State of Residence:


Marital Status:


Race/Ethnic Identification (for federal reporting purposes only):
African-American (non-Hispanic)
American Indian or Alaskan NativeAsian or Pacific Islander
Asian
Hispanic
White (non-Hispanic)
Other (please specify)


Highest grade completed:.


School Name:


Employment: List your last three (3) jobs, starting with your most current:
Start Date: -- mm/dd/yy


End Date: -- mm/dd/yy


Company:


Job Title:


Salary:


Start Date: -- mm/dd/yy


End Date: -- mm/dd/yy


Company:


Job Title:


Salary:


Start Date: -- mm/dd/yy


End Date: -- mm/dd/yy


Company:


Job Title:


Salary:


Referral Source:
Radio
Newspaper
Television
Friend
Other

Person to contact in case of emergency:


Phone:


SPECIAL NEEDS(Transportation, Child-care, Special access needs) Please explain:



Comments and/or Questions:


TO BE COMPLETED BY NON-US CITIZENS ONLY:
Country of Citizenship:


Permanent Resident:
Yes
No

If no, what is your visa status?.


Date: -- mm/dd/yy