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Health Education Programs Application Form

Please complete all sections of this application form clearly and accurately.

Submission of an application does not guarantee acceptance into a program.

1. Applicant Information

Date of Birth
Month
Day
Year

2. Program of Interest

Program of Interest
Medical Billing & Coding
Medical Assistant
Phlebotomy Technician
Pharmacy Technician
EKG Technician
Dental Assistant
Medical Administrative Assistant
Electronic Health Records Specialist
Sterile Processing Technician
Surgical Technologist
Veterinary Assistant
Other
Preferred Start Date:
Month
Day
Year
Learning Mode
Online

3. Educational Background

Highest Level of Education Completed:
High School Diploma
GED / Equivalent
Some College / Tertiary Education
Associate Degree
Bachelor’s Degree
Other
Do you currently attend a tertiary institution?
Yes
No

4. Employment Background

Are you currently employed?
Yes
No
Self-employed
Student only
Do you have any healthcare, office, customer service, or caregiving experience?
Yes
No

5. Reason For Applying

Please select all that apply:
I want to begin a healthcare career.
I want a career change.
I want a side job or additional income opportunity.
I am a recent high school graduate and want career direction.
I am currently in college/tertiary studies and want a skill to help support my studies.
I want training that may help me qualify for healthcare-related work.
I want professional development.
Other

6. Required Documents

Select

7. Non-Refundable Admissions Processing Fee

To begin the admissions review process, applicants are required to submit a non-refundable admissions processing fee of $30.00 USD.


This fee assists with administrative review, document verification, and application processing.

8. Application Agreement

Please read and acknowledge:

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Payment Portal

For your convenience, approved payments may be submitted securely through the payment gateway below. When making a payment, please include “Study” or your invoice code/reference in the payment reference, along with your full name.


Please note: Application fees are non-refundable.

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