ATDM Application

First Name

Middle Name:

Last Name

Email:

Street Address:

City

State

Zip Code

Please provide country you were born in if other than U.S.A:

Primary Phone:

Secondary Phone:

Gender (used for housing assignment only):

Highest Level of Education Obtained:

Date of Birth:

Are you currently or have you ever been in the United States military, a military dependent, or a military spouse?

The ATDM program offers training and certifications in five distinct areas. Please select your area of interest:

Please provide details of your work experience by listing your employer(s), job title(s), dates of employment, and reference contact(s) below:

If you are selected for the program, will you need housing?

If you are selected for the program, will you need transportation to and from class?

Please indicated how you were referred or learned about the ATDM program:

If selected into this program, please select the timeframe you would like to attend:

Were you referred to the program by an employer?

If selected in this program, list the location(s) you are willing to relocate to for employment after program completion:

Have you applied previously to the ATDM Program?

I consent to post-program contact by the ATDM staff in order to provide updates on training outcomes, job placement and career advancement. This information will help program administrators measure successes, improve training and market more effectively.

Please provide a brief explanation on why you are interested in the ATDM program:

Please note that acceptance into the ATDM program is contingent upon successfully completing both a criminal background check and a drug screening. All applicants are required to pass these screenings before finalizing their acceptance into the program. Generally, misdemeanors and convictions older than seven years may not affect your eligibility for acceptance. If you have any questions regarding specific offenses or concerns about your background, please don't hesitate to contact us at admissions@atdm.org. A final decision regarding your acceptance will be made once a comprehensive review of your criminal history has been completed. By entering my name below, I acknowledge that all information provided is complete and true, and I have read the above statement about admittance into the program.

Contact Information