VIDEO New! COURSE OVERVIEW JOB PLACEMENT FAQ TESTIMONIALS GALLERY REGISTRATION CONTACT US PAYMENT PLAN OPEN HOUSE SPONSORS * Denotes Required Fields PERSONNAL INFORMATION   Social Security Number* Start Date Preferred (mm/dd/yyyy) / / Full Name* Date of Birth / / Male Female   Legal residence of Applicant (State)*   / Since: US Citizen Yes No       CONTACT INFORMATION   Address 1*:     Address 2: Apt # City*:     State*:  Zipcode*: Home Phone: Work Phone: Cell Phone: Email*: Emergency Contact Name: Emergency Contact Number:     ROOM MATE PREFERENCES   I have a room mate already - Name: Want us to help you find a roommate? Yes No If yes, Smoking / Non Smoking   QUESTIONNAIRE   What level of experience do you have using the following machines? 1=None; 2=Beginner, 3=Experienced or 4=Expert Greenlee Tubing Benders Metal Lathe Milling Machine Vertical Band Saws Cold Cut Saws Horizontal Band Saws Tubing Knotchers Porta Band Saws Miller Wire Welders Miller Tig Welders Hydraulic Metal Shear Sheet Metal Break Sheet Metal Rollers Rotex Metal Punchers Iron Worker Oxygen & Acetalene Torch Plasma Cutter Bead Roller Hydraulic Press   List any schools beyond high school that you have attended: Name of school City/State Degree Earned       After graduating from the Hedgecock Fabrication Program, what is your desired career path? (Check all that interest you): Fabricator Body Mechanic Crew Chief Pit Crew Driver Operations Other: How did you hear about Hedgecock racing Academy? Radio Internet Postcard Magazine Newspaper TV High School Friend Name: Other Will you need any special services or accommodations? Yes No If so, please describe here or call our offices to discuss details: Please describe what you would like to achieve by attending Hedgecock Racing Academy : Please tell us how Hedgcock Racing Academy can help you achieve your goals in the motor sports industry: Please tell us who you have spoken with at Hedgecock Racing Academy: referral:

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