Student Registration – Nelson Security Academy

Student Information

Full Name *

Date of Birth *

Social Security Number (Last 4)

Driver License / State ID # *

State Issuing ID *

Contact & Address

Email Address *

Mobile Phone *

Home Phone

Preferred Contact Method

Street Address *

Apt / Suite

City *

State

ZIP Code *

Emergency Contact

Full Name *

Relationship *

Phone Number *

Course Selection

Select Your Course *

Training Format *

Preferred Class Date

Additional Information

Highest Level of Education

Currently Employed in Security?

Current Employer

Current Position

How Did You Hear About Us?

Identity Verification

Please upload a government-issued photo ID (Driver's License, State ID, or Passport). Accepted: JPG, PNG, PDF. Max 5MB.

Click to browse or drag your file here

Required for enrollment verification

Student Agreement & Signature

I confirm that the information I have provided is true and accurate. I understand that course completion does not guarantee the issuance of a Florida license or employment. I agree to follow all Nelson Security Academy classroom policies and conduct rules. I have reviewed the Privacy Policy, Terms & Conditions, and Refund Policy. I understand that providing false information may affect my enrollment.

Student Name (Electronic Signature) *

Date *

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