* = Required Information
Courses
Yes No
Certified Nursing Assistant
Cardio-Pulmonary Resuscitation (CPR) Certification
First Aid Certification
Automated External Defibrillator (AED)
Patient Care Technician
EKG Technician
Phlebotomy Technician
Pharmacy Technician
Medical Assistant
BLS CPR/First Aid Schedule
Note: There is a mandatory orientation 30 minutes before the scheduled start time on the first day of class for all students. Students must be in uniform for the 60 minute orientation. The orientation date for your class will be provided upon registration.
Former Student
Relative/Friend
On-line/Internet
Facebook
TV
Magazine
Career/Job Fair
Other
Yes No
Black or African American
Asian or South Pacific Islander
American Indian or Alaskan Native
White or Caucasian
Hispanic
Latino
Other
Yes No
Yes No
Yes No
Yes No
References
(Give the name, address and telephone number of two relatives/friends for emergencies)

Upload File

These are required documents that can be uploaded now or presented when you pick up your uniform.
These are required documents that can be uploaded now or presented when you pick up your uniform.
Applicant Statement
I certify that all information and statements contained herein are correct and complete. I understand that discovery of false statements are grounds for immediate dismissal.