May 27 NEW HCA Student Registration Form

Student Registration Form

Provide your details, credentials, and signature to secure your registration for our course offerings.
Student Data
The Workforce Board (the state agency that regulates this school) requires that we ask you for this information, by law (RCW 28C.10.050). Providing your social security number is voluntary. By law, the information you provide on this form cannot be given out by any state agency as public information. The Workforce Board will not disclose data to anyone except authorized Workforce Board employees or contractors working on specific research activities, who follow strict confidentiality procedures. This format follows the information required to be submitted by the school as part of the annual student data report.
Full Name (as shown on your government ID).

First NameMiddle InitialLast Name
Mailing Address

Street Address

Street Address Line 2
CityStateZip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth

MonthDayYear
Date
SSN Number
If no SSN leave field blank
Email Address
example@example.com
Race (Check only one box)

Other
Are you Hispanic in origin?
Sex
Are you disabled?
Are you a military veteran?
Employment Status
Optional career support services are available for those currently seeking employment for a fee. Please indicate if you would like to sign up.
Highest grade completed

Step 5 of 5: How did you hear about us?
How did you hear about Sparkle Training Center?
If you selected student referral, enter the students name
Today's Date - Must be on the same date you are completing this form!

MonthDayYear
We’re excited to have you join us! Please note that Applications submitted after 4:00 PM PST will be processed on the next business day.
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Student Registration Form