American PFTA


THE MISSION
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Certified Personal Trainer
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Register


* Indicates required fields

GENERAL INFORMATION		    
Last Name *
 First Name *

 Middle Initial

Maiden Name (if Applicable)

    
Street Address *

 City *

 State *
Country (if other than U.S.)

 Zip Code *
E-mail Address *

Phone *
Day Evening
The best time to call me is
PERSONAL
Date of Birth
/ /
MM/DD/YYYY		 Driver's License Number
   
Gender:
  Male      Female		  
EDUCATION
I have graduated from
high school:
Yes No		 I am planning to graduate
from high school:
Yes No		 I have received a GED certificate:
Yes No		 I am expecting to receive a GED certificate:
Yes No
If Yes, Month/Year
/
MM/YYYY		 If Yes, Month/Year
/
MM/YYYY		 If Yes, Month/Year
/
MM/YYYY		 If Yes, Month/Year
/
MM/YYYY
Name of High School

 City

State

Name As It Appears on High School Academic Records

Have you applied to THIS institution before?
Yes No
If yes, for which year?

(YYYY)

Have you attended college before?
Yes No

If you have attended college, approximately how long did you attend?
Less than 1 year
1-2 years
2-3 years
3-4 years

Degree Received?
Yes No

Extracurricular Activities (such as community or school involvement)

EMPLOYMENT
Current Employer

 Position

Duties


Please describe your current work schedule:

GYM MEMBERSHIP
Are you currently a member at a gym?
Yes No
If so,
What is the name of the gym?
What is the Managers name (if you know it)?
What is the phone number at the gym (if you know it)?
Please describe your current level of fitness activity?
Please describe your anticipated level of support from friends and family:

FINANCIAL
Have you set money aside for your education?
Yes No
  Method of Payment
I will pay for my entire term charges on or before registration.
I will provide a letter from an authorized company or agency confirming that it will pay my entire charges each term.
I will require financial assistance to help pay my term charges. If necessary, my  
co-borrower will be:  

Are you a U.S. citizen? Yes No

How you heard about Personal Fitness Trainer Associate *

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