Registration Personal InformationName* First Last Address* Street Address City State Zip Phone*Email* Date of Birth* MM slash DD slash YYYY Gender*FemaleMaleTransgenderOtherHigh School InformationDiploma Type*High School DiplomaGEDYear Issued* Place Issued* How did you hear about us?*WebsiteTVRadioFacebookFriendotherProgram SelectionPlease choose the course you would like to register for below.Phlebotomy Technician Monday 6pm-10pm/Wednesday 6pm-9pmMonday November 22 , 2021 to Wednesday December 22, 2021Clinical Medical Assistant Monday 6pm-10pm/ Wednesday 6pm-9pmMonday November 22, 2021 to Wednesday January 26, 2021Phlebotomy Technician Wednesday 12pm-4pm/ Friday 12pm-3pmWednesday November 24, 2021 - Friday December 24, 2021Clinical Medical Assistant Wednesday 12pm-4pm/ Friday 12pm-3pmWednesday November 24, 2021 - Friday Jan 28, 2022WAITLIST ONLY-Phlebotomy Technician Saturday 8am-12pm/Sunday 8am-11amSaturday November 20, 2021 to Sunday December 19, 2021WAITLIST ONLY- Clinical Medical Assistant Saturday 8am-12pm/ Sunday 8am-11amSaturday November 20 - Sunday February 6 (Holiday Break Dec 25-Jan 2 No Class)Once you have completed the registration form you must click the red SUBMIT REGISTRATION bar below.
