LJIC Application for Enrollment

Go confidently in the direction of your dreams. Live the life you have imagined.

-Henry David Thoreau

Program of interest *
LJIC Location you are interested in: *
Program Start Date *
Confidential
Name * First Last
Social Security # *
Permanent Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone * - (###) - ### ####
Birth Date / MM / DD YYYY
Email *
Name & Address of person to be notified in the event of an emergency
Name First Last
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Relationship
Phone - (###) - ### ####
Parent or Guardian's Name First Last
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone - (###) - ### ####
Education
High School Attended
Year Graduated or GED Completion Date
College or Vocational School Attended
Last Level of Education Completed
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
If you attended a college or vocational school, did you receive financial aid while attending? Yes No
If yes, what is your DRN (Data Release Number)?
Before submitting, remember to enclose the $150.00 application & registration fees. The $50.00 application fee is non-refundable. Please submit this application to the La' James International College you plan to attend.
Type the letters you see in the image below.