Health Careers Staffing and Training

School Admission Application

All prospective students are required to complete this application for admission.

First Name *

Last Name

Social Security Number

Phone Number (Including Area Code)

Email Address *

Mailing Address

City

State

Zip/Postal Code

Program(s) you want to apply for (please check one or more):

Nurse Aide Assistant

EKG Technician

Phlebotomy Technician

Patient Care Technician

Home Health Aid

Total: $0

Please document your schooling/educational history in the spaces provided below. Please write ‘N/A’ for information that does not apply to your situation.

Type of Schooling: High School / GED / Homeschool

School Name, City, and State

Dates Attended

Did You Graduate?

Type of Schooling: College / University

School Name, City, and State

Dates Attended

Did You Graduate?

Type of Schooling: Trade School / Technical College

School Name, City, and State

Dates Attended

Did You Graduate?

Type of Schooling: Other (Please Describe)

School Name, City, and State

Dates Attended

Did You Graduate?

List your reasons for wanting to attend HC Staffing & Training

How did you hear of HC Staffing & Training?

Please select at least one option.

HC Staffing & Training LLC admits students and makes available to them its programs of study without regard to race, color, sex, religion, national origin, sexual orientation, or disability. I attest to the accuracy of the information supplied in this application for student admission. A completed application is not a guarantee of admission. Applications are not considered complete until all documents have been provided. *

Invoice item

Price

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