DiverseNote Mobility Program Application Enroll Today Please enable JavaScript in your browser to complete this form.Name *FirstLastAddress *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *Phone *Do you currently use the DiverseNote career management platform? *YesNoRace / Origin *American Indian or Native AlaskanAsian or Pacific IslanderThird ChoiceAfrican AmericanHispanicWhiteOtherGender *MaleFemaleNon-binaryPrefer not to answerAge *Date of Birth *MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Highest level of education. *Less than high school diplomaHigh school diploma or GEDGraduate of vocational programBachelor's degreeMaster's DegreeDoctoral degreeApplicants are requested to provide the following information voluntarily. Are you a veteran of the U.S. Military? YesNoDo you have a disability?YesNoNative LanguageWhat program are you applying for? *Computer LiteracyEarly Career Pre-ApprenticeshipInto to CybersecurityIntermediate CybersecurityEnterprise CybersecurityIntro to ProgrammingIntermediate ProgrammingEnterprise ProgrammingAutonomous TechnologyElectric VehiclesMachine LearningEntrepreneurshipHospitality ManagementAuto MechanicsOnline or in-person training? *OnlineIn-personWhat schedule are you interested in? *Morning (9AM-12PM)Afternoon (1PM-4PM)Evening (6PM-9PM)Learn at my own paceWhen would you like to start? *Spring - between April and May 2021Summer - between June and August 2021Fall - between September and November 2021Winter - between December 2021 and March 2022What tuition payment option do you qualify for? *Pay tuition in fullTuition payment planGI BillMINGSTAPMichigan Skills ScholarshipNeed Based ScholarshipOther Tuition Assistance (workforce development, MRS, etc.)Housing Preference *On-campus if availableOff-campusWhy have you decided to take a DiverseNote Mobility program? *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? *YesNoIf your records have been expunged pursuant to applicable law, you are not required to answer yes to the following questions. If you are unsure whether to answer yes, we strongly suggest that you answer yes and fully disclose all incidents. If yes, please explain.Remaining QuestionsThe remaining questions in this application can be answered later. If you wish to respond to the questions below at a later time, be sure to review and agree to the terms at the bottom of the application and click submit before you exit the application.High School InformationIf you are a current high school or GED program student, please complete this section.High School NameExpected Graduation DatePlease provide the names of people in your immediate family who have attended DiverseNote Mobility.NameFirstLastRelationshipExtracurricular, Personal and Volunteer ActivitiesExtracurricular ActivitiesList your organizations, position, description of the activity, and hours per week of involvement.Talents and AwardsList each, a description, the level, and number of years of involvement.Community Service WorkList the type of work, your role, and hours per week of involvement.EmploymentList the job, your title, description, hours per week, and dates of employment.Attach an additional Word, PDF or text document if necessary. Click or drag a file to this area to upload. Household InformationThis information is required if you are under 26 years old.Father or Legal Guardian OccupationFather or Legal Guardian EducationHigh School or LessTrade or Vocational SchoolSome CollegeUndergraduate College DegreeGraduate DegreeMother or Legal Guardian OccupationMother or Legal Guardian EducationHigh School or LessTrade or Vocational SchoolSome CollegeUndergraduate College DegreeGraduate DegreePlease indicate your family’s gross income for the most recent tax year. Include both taxed and untaxed income.Less than $20,000$20,000 - $39,999$40,000 - $59,999$60,000 - $79,999$80,000 or moreDo you have family obligations that keep you from participating in extracurricular activities?NoYes, I have to work to supplement family income. Yes, I provide primary care for family member(s). OtherIf yes or other, please describe:For Non-U.S. Citizens OnlyCity and Country of BirthAgreementI 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.Do you understand and agree to the terms listed above? *Yes, I understand and agree to the terms listed above. Events, activities, programs and facilities of the Academy are available to all without regard to race, color, marital status, gender, religion, national origin, disability, age, nor veteran status as provided by law and in accordance with the Academy's mission of all-inclusive diversity.NameSubmit