ENROLLMENT APPLICATION

First name*

Date of Birth required

Last name*

Last 4 Digits of Social Security #

Phone

Street Address

Street Address Line 2

City

Postal / Zip code

Region/State/Province

Valid Driver’s License

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Upload supported file (Max 15MB)

DOT Physical Examination Upload (CDL Program Only)

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Fingerprinting and FBI Background Check Documentation (CNA Program Only)

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Proof of High School Diploma or GED (Not Required for CDL Students)

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Tuberculosis (TB) Skin Test Results Documentation (CNA Students Only)

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Supplementary Documentation Upload

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Add CPR certification for $60.

I certify that all information provided above is true and correct.

Thank you for submitting! Please check your email for the enrollment application!