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ASU REGISTRATION (Step 1 of 6): SUBMIT PERSONAL DATA
Course Number
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Employer Funded Training?
Name of Employer
First Name
Last Name
Mailing Address
City
Province/State
Postal/Zip Code
Country
Cell
Email
Date of Birth (dd/mm/yy)
SELF-DECLARATION OF MEDICAL FITNESS
DISEASE/CONDITIONS?
Describe Condition
SUBSTANCE ABUSE?
Describe Substance Abuse
PSYCHOLOGICAL and/or EMOTIONAL ILLNESS
Describe Emotional Illness
VISUAL ACUITY PROBLEMS?
Describe Visual Acuity Problems
HEARING ACUITY PROBLEMS?
Describe Hearing Acuity Problems
FINE MOTOR SKILLS PROBLEMS?
Describe Fine Motor Skills Problems
PHYSICAL FITNESS PROBLEMS?
Describe Physical Fitness Problems
LIFTING ABILITY PROBLEMS?
Describe Lifting Abilities Problems
By clicking 'NEXT' below, the student confirms they have answered all questions truthfully, and that they will be at least 19 years of age on day 1 of their course.
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