SIGN UP

To sign up for an upcoming course, please fill out the following:

COURSE INFORMATION

Course I am interested in:
  I would like to reserve a place in the course & dates chosen above
  I DO NOT wish to reserve my place in the course & dates indicated above, but only have questions

PERSONAL INFORMATION

First Name:
Last Name:
Your Email:
Primary Phone:

PAYMENT INFORMATION

How would you like to pay?:  GI Bill Other VA Benefits Credit Card Check Cash
DEPOSIT

To reserve a place in the course chosen above, we ask for a $50 fully refundable deposit made via credit or debit card. Once you sign in on the first day of the course, this deposit is refunded. How would you like to make this $50 deposit?:  Credit Card Debit Card Other

VETERAN SECTION (Complete this section if using VA Benefits for HTPS or CAPS only)

What is your current military status?:  Active Retired Former Reserve
What Branch: Army Navy Marines Air force Coast Guard Guard Other
Veteran's Benefits you plan to use:
Have you applied for your GI Bill Letter of Eligibility?:  Yes No Applying Today N/A
Do you have your GI Bill Letter of Eligibility?:  Yes No Not Sure N/A
Have you used, or are you currently using, your GI Bill benefits?:  Yes No Not Sure N/A

IMPORTANT VETERAN BENEFITS INFORMATION

To use your GI Bill benefits, you must apply for you benefits here: (apply for veteran benefits here) The school name to use in the application process is:

MiraCosta College CS/BD
1 Barnard Drive
Oceanside, CA 92056

1) NEVER USED MY BENEFITS: If you are finished with your active service and have not yet used your benefits, it may take between 2 - 8 weeks to get your Letter of Eligibility so please apply asap

2) ALREADY USED MY BENEFITS: If you have used your benefits already, you will need to transfer your benefits to our institution by submitting the VA Form 22-1995 online

3) ACTIVE DUTY: If you are still active, you can still use your benefits by going to the above VA benefits website, applying for GI Bill benefits, and submitting VA Form 22-1990 online

4) TUITION ASSISTANCE (Active Duty): Please check with your base education office or call the GI Bill division of the Veterans Administration to get details at 1-888-442-4551

TRAVEL & LODGING

How are you traveling to San Diego for training?: I'm Local Air Travel Driving Other
Do you require hotel lodging during training?:  Yes No Not Sure N/A
If staying in a hotel, do you want to share a room with another student?:  Yes No N/A

LIABILITY

Have you ever been convicted of a felony?:  Yes No
Have you ever been convicted of any domestic violence charge?:  Yes No
Are you legally allowed to possess and/or handle firearms?:  Yes No
Are you physically capable of engaging in rigorous training?:  Yes No
Are you mentally capable of engaging in high stress training?:  Yes No

OTHER TRAINING PROGRAMS

What other program{s} interest you?: 19 - day HTPS EP Skills Tactical Combat Casualty Care  CAPS High Threat Intro EP1 Mexico Protection Specialist TFR Cert Other

REFERRAL INFORMATION

How did you find out about our training programs?: Google Search Bing Search Yahoo Search Youtube Friend Secfor International APG Linked in Facebook Other (detail below)
Other:

ELECTRONIC SIGNATURE

By checking YES**, typing my full legal name, I certify that the above information is true and accurate to the best of my knowledge?: YES**
Full Legal Name:

Questions or Comments:

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