Registration Personal InformationName* First Last Address* Street Address City State Zip Phone*Email* Date of Birth* Date Format: 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 June 7, 2021 to Wednesday July 7, 2021Monday 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 June 7, 2021 to Wednesday August 11, 2021Monday September 13, 2021 to Wednesday November 17, 2021Phlebotomy Technician Wednesday 12pm-4pm/ Friday 12pm-3pmWAITLIST ONLY - Wednesday June 9 , 2021 to Friday July 9, 2021Wednesday September 15, 2021 to Friday October 15, 2021Clinical Medical Assistant Wednesday 12pm-4pm/ Friday 12pm-3pmWAITLIST ONLY- Wednesday June 9, 2021 to Friday August 13, 2021Wednesday September 15, 2021 to Friday November 19, 2021Phlebotomy Technician Saturday 8am-12pm/Sunday 8am-11amWAITLIST ONLY -Saturday June 5, 2021 to Sunday July 11, 2021 (No Class 7/3 & 7/4)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 June 5, 2021 to Sunday August 15, 2021 (No Class 7/3 & 7/4)Saturday September 11, 2021 to Sunday November 14, 2021Once you have completed the registration form you must click the red SUBMIT REGISTRATION bar below.
