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-9pmWAITLIST ONLY -Monday September 13, 2021 to Wednesday October 13, 2021Monday November 22 , 2021 to Wednesday December 22, 2021Clinical Medical Assistant Monday 6pm-10pm/ Wednesday 6pm-9pmWAITLIST ONLY - Monday September 13, 2021 to Wednesday November 17, 2021Monday November 22, 2021 to Wednesday January 26, 2021Phlebotomy Technician Wednesday 12pm-4pm/ Friday 12pm-3pmWAITLIST ONLY - Wednesday September 15, 2021 to Friday October 15, 2021Clinical Medical Assistant Wednesday 12pm-4pm/ Friday 12pm-3pmWAITLIST ONLY- Wednesday September 15, 2021 to Friday November 19, 2021Phlebotomy Technician Saturday 8am-12pm/Sunday 8am-11amWAITLIST ONLY Saturday September 11, 2021 to Sunday October 10, 2021Saturday November 20, 2021 to Sunday December 19, 2021Clinical Medical Assistant Saturday 8am-12pm/ Sunday 8am-11amWAITLIST ONLY Saturday September 11, 2021 to Sunday November 14, 2021Saturday 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.
