Part-Time Enrollment Application

16-week part-time program, two weekday nights and alternating Saturdays

Date of Application:	(MM/DD/YY) required
Year:	required
Month:	required
First Name & MI:	required
Last Name:	required
Address:	required
Addl. Address:
City:	required
State/Province:	required
Zip/Postal Code:
Country:	required
Home Phone:	(XXX-XXX-XXXX) required
Work Phone:	(XXX-XXX-XXXX)
Cellular Phone:	(XXX-XXX-XXXX)
E-mail Address:	(you@something.com)
Social Security #:	(XXX-XX-XXXX)
Date of Birth:	(MM/DD/YY) required
Person to Contact in Case of Emergency:	required
Relation to Student:	required
Phone #:	(XXX-XXX-XXXX) required
Are There Any Medical Conditions We Should Be Made Aware Of:	Nonerequired
Do You Have a High School Diploma or GED?	Yes: No: If yes, please forward a copy of your diploma or transcript to Ritop.
Any College Credit?	Yes: No:
How Did You Hear About Ritop:
Do You Need Housing?	Yes No
Additional Information or Questions:
All applications require a non-refundable $50.00 Administrative Processing Fee. Tuition fees paid after your application is accepted are refundable per Massachusetts law.
*Deposit Payment Information*
Payment type for the required deposit: Personal or Bank Check (Payable to Ritop) Credit Card: Credit Card Number Expiration Date: (MM/YY)	*We Accept:* MasterCard, Visa, Discover and American Express credit cards and also Personal & Bank Checks. If paying by check, send deposit payment with a printed copy of this form to: The Ritop School for Mobile Electronics Attn: Admissions 200 Dexter Avenue Watertown, MA 02472 Toll-Free 1-888-44-RITOP 617/923-4043 Fax 617/923-4886 Credit card transactions submitted via this form are not encrypted. If you are concerned about maintaining security of your credit card number, please call toll-free 1-888-44-RITOP or 617/923-4043 with your credit card information, or fax your name, address, credit card number and expiration date to 617/923-4886.
*By Sending This Application for Enrollment, I Certify That all the Above Information is True and Complete to the Best of My Knowledge. I further agree to all the rules and regulations for enrollment at Ritop.***

All applications are subject to approval by the admissions department based on availability of class openings.
All information submitted remains private and confidential. The course offerings and school calendar are subject to change without notice.

To apply you may also download an application in PDF form from our publications page and mail or fax it to us.