Preferred Name (if different from legal name)
*Enter Birth Date as MM/DD/YYYY: example 12/31/2021
Race (Choose one or more)
US Citizenship Status
Social Security or ITIN Number
A valid social security number may be required for licensure and future employment. Please check with Enrollment Services to determine if your industry program requires an SSN for licensure or employment.
Your social security number is used for several purposes:
-- to administer financial aid -- to verify academic records -- to conduct research -- to report payments you made that may qualify for a tax credit or a tax deduction on your income tax return
We are required to ask for your SSN/ITIN. If you do not submit it, you will still be able to enroll at Perry, but you may be subject to an IRS penalty of $50. We will always protect your personal information from unauthorized use and disclosure.
If you do not wish to disclose your SSN/ITIN, select "Unknown" as your US Citizenship Status above.
Have you lived in Washington state for at least the last 30 days?
In what state are you currently a resident?
Have you ever been in state, tribal, or federal foster care while living in Washington State?
This is used to determine your eligibility for support services and awarding financial aid. It will not affect your admission to Perry.
Perry Technical Institute is committed to welcoming students who have disabilities, and to working with those students on reasonable accommodations to allow them an equal opportunity to benefit from our programs.
If you have a disability and believe that you may need an accommodation, would you like to discuss your need for accommodations?
BECAUSE YOU SELECTED YES, THE EXAM CENTER MANAGER WILL CALL YOU WITHIN 48 HOURS TO SET UP A MEETING TO DISCUSS DISABILITY ACCOMMODATIONS FOR THE ENTRANCE EXAM. PLEASE DO NOT SCHEDULE YOUR TEST WITHIN 48 HOURS IF YOU WOULD LIKE ACCOMMODATIONS FOR YOUR EXAM.
Have you ever been found guilty or convicted of a felony?(Answering yes will not prevent you from enrolling at Perry)
If yes, please explain what happened. If you would rather talk to someone in person about your situation, you may leave this field blank.
Choose a program of study.
Please note – you must be 21 years of age, have had your driver's license for a minimum of 5 years, and have a current Washington state driver's license to enroll in Professional Truck Driving.
This program requires that you obtain a Commercial License Permit (CLP) from the Department of Licensing. Due to federal and state regulations, students are required to have proof of lawful permanent residency, US citizenship, or non-domicile document upon applying for the CLP. For more information on the documents that meet this requirement, please contact the Enrollment Department. Students will need to be prepared with this proof prior to the second week of the program.
This program requires that you obtain a Washington State Trainee Certificate before the first day of class. Due to the regulations set forth by the Department of Labor and Industries, a social security number is required to submit the online Trainee Certificate application. Candidates without a social security number are unable to qualify for a license in the State of Washington which may affect employment in the field.
Do you currently have or have you ever had an electrical trainee license?
Please enter your Electrical Trainee license number.
Please enter your Electrical Trainee License expiration date.
What year do you plan to begin your program?
What term do you plan to begin your program?
What month do you plan to begin the program?
Is this your first time attending Perry Technical Institute?
Proof of a valid driver's license and a five-year driving record is required to enroll.
Proof of a valid driver's license will be required prior to program start date.
Please enter your driver's license number.
How did you hear about Perry Technical Institute?
Primary Phone Number
Mobile Phone Number
We occasionally use texting for things like exam appointment reminders. Do you want to receive text messages?
Emergency Contact Information
Emergency Contact Name
Emergency Contact Phone Number
What is their relationship to you?
Additional Email Contact
Please provide an additional email address (ie parent/spouse/etc.) to receive all email communications, updates, and resources regarding your enrollment.
Release of Information
Perry Tech respects your privacy and will not release your personal information without your permission, except as permitted or required by law. If you would like to give access to another person so that we can discuss your information with them, please complete this Release of Information form.
More information about your rights with respect to your education records can be found in our Annual Notification of Rights Under the Family Educational Records and Privacy Act (FERPA).
Would you like to give Perry Tech permission to release your personal information to someone other than you?
You should only submit one release form per code word. If you have multiple people who will use the same code word, include them on the same release.
List the people you want on this release. Include as many names as you want.
What type of information should be available for this release?
What is the code word for this release?
Would you like to add another release?
List the names of people who can access your information:
Please notify those to whom you have granted access that they will need to provide the code word to access your records. You can change your code word at any time by contacting the Registrar’s Office.
Please select the option that applies to you.
Please select the state your high school is located in.
Please select your high school from the list. If you cannot find your school select "School not listed".
Please enter the name of your high school.
Please enter the City your high school is in.
Please select the state your high school is in.
Do you have a GED?
GED Testing Center State.
High School Graduation or GED Exam Year (####)
If you have not yet graduated, use the year you plan to graduate.
What is the highest level of education you’ve completed? If you are still in high school, choose high school diploma.
Are you a United States Veteran?
In what branch of the military did you serve?
Are you currently on active duty in the United States military?
In what branch of the military are you currently on active duty?
These questions will be used to confirm your identity when you call Perry Tech.
Please select your first security question.
Please answer your first security question.
Please select your second security question.
Please answer your second security question.
Perry Technical Institute Disclaimers
By submitting this form, I agree to allow Perry Technical Institute to use the information provided to contact me by telephone, text, SMS, and email with details regarding my enrollment status.
Electronic Signature Notice: Electronic signatures are the legal equivalent of your manual/handwritten signature.
For more information about our graduation rates, the median debt of students who completed the program, and other important information, please visit our website at: http://www.perrytech.edu/programs/disclosures/
The Family Educational Rights and Privacy Act (FERPA) affords students certain rights with respect to their education records. More information about your rights and our privacy practices can be found in our Annual Notification of Rights Under the Family Educational Records and Privacy Act (FERPA).
Perry Technical Institute does not discriminate on the basis of race, color, religion, national origin, age, ancestry, sex, veteran or military status, sexual orientation, or the presence of any sensory, mental, or physical disability or the use of a trained guide dog or service animal by a person with a disability in its programs and activities. The following person has been designated to handle inquiries regarding the nondiscrimination policies:
Title IX Coordinator
| Perry Technical Institute | 2011 W. Washington Ave. | Yakima, WA 98903
| 509.453.0374 or 888.528.8586 | Email: email@example.com
I consent to receive emails on my personal/PTI email accounts of financial aid information which may include award letters, loan disclosures, disbursement notifications and other financial aid information. I understand I may request a paper copy at any time from the financial aid office.
You will receive a verification email within 24 hours. When you receive the email please respond so that we can verify that our emails are reaching you.