Apply - Mobility Program Application

Email *

Phone *

Name *

First

Last

Address *

Address Line 1

City

State

Zip Code

Do you currently work with a workforce development office or career coach *

Yes
No

(For example, Michigan Works, Chicago Cook Workforce Partnership, etc.)

What s the Full name, email address, and phone number of the career coach you are working with? *

If you have a training approval number, enter it here.

DiverseNote Mobility offers multiple options for tuition and fee payments including affordable payment plans and/or tuition assistance. Our programs do require tuition and one of the options below must be selected to pay tuition and fees. Please select at least one.

DiverseNote Mobility offers multiple options for tuition and fee payments including affordable payment plans and/or tuition assistance *

There are different programs/links. Each link provides the tuition amount

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Enter your zip code below to identify your local office and contact them to schedule orientation for tuition assistance. https://www.careeronestop.org/LocalHelp/AmericanJobCenters/find-american-job-centers.aspx?location=

Credentialing Assistance | Army National Guard Credentialing Assistance | Army National Guard: https://nationalguard.com/education-programs/credentialing-assistance

What workforce development tuition assistance amount have you been approved for? *

Gender *

Date of Birth *

Race *

Highest level of education. *

Military Affiliation *

Do you have a disability? *

What program are you applying for? (View academic program information at https://diversenote.mobi/programs) *

Are you interested in Dual Enrollment? *

Online or In-person training? *

What schedule are you interested in? *

Weekday Morning (9AM-12PM)
Weekday Afternoon (1PM-4PM)
Weekday Evening (6PM-9PM)
Weekend Morning (Saturday and Sunday 9AM-12PM)

When would you like to start? *

Spring - between April and May
Summer - between June and August
Fall - between September and November
Winter - between December and March

Why would you like to enroll in a DiverseNote Mobility Program? *

What tuition payment option do you qualify for? *

Pay tuition in full
Tuition payment plan
Military Tuition Assistance Program (CA, MyCAA)
Michigan Achievement Scholarship
Detroit at Work
Other Tuition Assistance (need based, workforce development, MRS, etc.)

If GI Bill, which chapter? *

Are you currently or have you ever been charged with or subject to disciplinary action for scholastic or any other type of misconduct at any educational institution? *

Yes
No

High School Name *

Current High School Students or GED applicants

Expected Graduation Date

If Applicable

City and Country of Birth *

International Applicants Only

I understand that this application is for admission only for the term indicated. I agree that I am bound by the Academy's regulations concerning application deadlines and admission requirements. I agree to the release of any transcripts and test scores to this institution, including high school and/or college GPA, reading and math level, any SAT, and/or ACT score reports. I certify that this information is complete and accurate. I understand that making false or fraudulent statements within this application or residency statement may result in disciplinary action, denial of admission and invalidation of credit or degrees earned. If admitted, I agree to abide by the policies of the Board of Regents and the rules and regulations of the Academy. Should any information change prior to my entry into the Academy, I will notify the Office of Admissions.

DiverseNote Mobility Program Application