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Enrollment Application

You're one step closer to starting your healthcare career.

Reserve Your Seat

Once you complete and submit this application, you may submit a non-refundable payment of $100 to reserve your seat.

Enrollment Acknowledgements

Please confirm each item before submitting your application.

I meet the minimum age requirement (16 years of age or older).I understand the program requirements.I understand the required background check and drug screening.I understand the attendance and completion requirements.I have reviewed the program schedule.I understand the immunization requirements (TB test/chest X-ray within one year and required immunizations).I understand the enrollment fee is non-refundable once my enrollment is confirmed.I understand that meeting the requirements is my responsibility.

Contact Information

First Name *

Last Name *

Email Address *

Phone Number *

Zip Code *

State *

Program of Interest *

By submitting, you confirm all acknowledgements above are true and accurate.