Required fields in red
Personal Information
First Name:
Last Name:
Address:
City:
State:
Zip:
Home phone:
Work phone:
Cell phone:
Email:
Are you in good health?
Are you a citizen of the United States?
Are you a convicted felon?
Are you married?
How did you hear about RSI?

(If referred, please list name)


Education and Work Information
Check one that applies High School Diploma GED None
Name of High School
City:
State:
Do you have any trouble reading or writing English?
If yes, what language do you speak fluently? 
Have you set aside the funds for your education?
Will your family assist you financially?
Class start date (MM/DD/YY):
Class start time:

Course:
Please tell us why you want to come to The Refrigeration School, Inc.: