Quest Nursing Education Center 2135 Broadway, Oakland, CA P: (510) Enrollment Application

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Quest Nursing Education Center 2135 Broadway, Oakland, CA 94612 P: (510) 452-1444 www.questnursingeducationcenter.com. Enrollment Application"

Transcription

1 STUDENT INFORMATION Enrollment Application Name: Address: Phone: Last First MI Other Name Used Number / Street City State Zip Daytime Evening Message DOB: SSN: - - POB: mm/dd/yyyy Place of Birth DL / ID Number: Height: Weight (lbs): Hair Color: Eye Color: Male: Female: Primary Language: Name of Primary Language English: if English only Have you ever been convicted of a crime other than a minor traffic violation? Yes No How did you find out about us? EMERGENCY CONTACT Name: Address: Phone Relationship: PREVIOUS EDUCATION High School: Dates Attended: Graduation Date: GED: From: mm/yyyy To: mm/yyyy mm/yyyy if GED only College: Graduation Date: Degree: Name of Institution mm/yyyy I certify under penalty of perjury that the above information provided by me the applicant is true and correct. I understand that falsifying any information is grounds for immediate dismissal without a refund. Name: Signature: Date: Print Name Here Quest Nursing Education Center 2135 Broadway Oakland, CA 94612

2 CERTIFIED NURSING ASSISTANT: Are you at least 16 years old? STUDENT ELIGIBILITY CHECKLIST: PLEASE FILL OUT FOR THE COURSE YOU ARE ENROLLING IN Are you legally able to work in the United States Are you in good physical and mental health* Do you have a Valid Social Security Number *Please note that admission into the program is contingent upon successfully passing a medical physical exam which includes a PPD Tuberculosis skin test and/or Chest X-ray indicating good health by a licensed physician or Nurse Practitioner. HOME HEALTH AIDE: Have you successfully completed a California State approved Nursing Assistant Program and Eligible for licensure as a Certified Nursing Assistant*: * Please note that certification as a Certified Home Health Aide is contingent upon successful certification as a Certified Nursing Assistant. IV THERAPY/BLOOD WITHDRAWAL (LVNs) Have you successfully completed a California State approved Vocational Nursing Program and are Eligible for licensure as a Licensed Vocational Nurse*: Please note that certification in IV therapy and Blood Withdrawal is contingent upon successful Licensure as a Licensed Vocational Nurse EMERGENCY MEDICAL TECHNICIAN (EMT) Are you at least 16 years old? Yes No Are you legally able to work in the United States Are you in good physical and mental health* Do you have a Valid Social Security Number Do you have a High School Diploma or GED equivalent *Please note that admission into the program is contingent upon successfully passing a medical physical exam. In addition The following immunizations are required: MMR Vaccination (Measles Mumps Rubella), Hepatitis B, TB Test- (Tuberculosis) and the test must be within the past 6 months before the class start date. If known to be PPD positive, must have a negative chest x-ray. FOR ALL APPLICANTS: Are you currently under investigation or have ever been arrested of an infraction, misdemeanor, or felony in California or any other state or place including entering a plea of nolo contendere or no contest and including any conviction which has been expunged (set aside) or records sealed.** **If you are currently under investigation or have ever been arrested of an infraction, misdemeanor, or felony in California or any other state or place including entering a plea of nolo contendere or no contest and including any conviction which has been expunged (set aside) or records sealed. You must disclose action(s). Falsifying this information may result in the inability to receive certification and Quest Nursing Education Center will NOT be liable for tuition and expenses paid if found ineligible for certification. I certify under penalty of perjury that the above information provided by me the applicant is true and correct. I understand that falsifying any information is grounds for immediate dismissal without a refund. Name: Signature: Date: Print Name Here Quest Nursing Education Center 2135 Broadway Oakland, CA 94612

3 TUITION BREAKDOWN- Please select payment plan and enclose applicable fees CNA PROGRAM TUITION BREAKDOWN $ 150 Application Fee $ 250 Deposit $ 150 Supplies $ 350 Tuition $ 25 Professional liability insurance Total Fees: $925 Payment Plan Option 1: To Register: Pay $150 (Includes Application Fee) Pay $750 Prior to class start date: Receive CPR FREE!!!* * Required Textbook for CPR not included in free course but may be purchased from Quest Nursing Education Center for $15. Payment Plan Option 1: To Register: Pay $150 (Includes Application Fee) First day of class: $375 (Also due is $25 insurance) Two weeks into class: $375 Full payment: ( Enclose $925) Payment Plan Option 1 : ( Enclose $150) Payment plan Option 2: ( Enclose $150) HHA TUITION: $350 IV THERAPY/BLOOD WITHDRAWAL TUITION: $350 EMT PROGRAM TUITION BREAKDOWN: $ 150 Application Fee $ 500 Deposit $ 250 Supplies $ 850 Tuition $ 25 Professional liability insurance Total Fees: $1775 Payment Plan Option: To Register: Pay $675 (Includes Application Fee, Deposit, and Insurance) First day of class: $350 Two weeks into class: $350 Last day of class: $400 Official Use Only Fee Status: AF PP PIF Dates/Amounts: / / / Reviewed By: Initials Quest Nursing Education Center 2135 Broadway Oakland, CA 94612

4 QUEST NURSING EDUCATION CENTER REFUND POLICY: All courses that cost $350 or less is not refundable. For courses above $350: The student has a right to a full refund of all charges less the amount of the application fee if he/she cancels this agreement at least 7 days prior to first day of instruction. Beyond 7 days to first day of instruction, the tuition deposit and the application fee becomes nonrefundable. In addition, the student may withdraw from a course once instruction has started and receive a pro rata refund minus the application fee, tuition deposit, and supplies cost, if the student has completed less than 60% of the instruction. Daily rate for tuition is calculated by total fees paid divided by number of days. No refund is available once 60% or more of the class has been completed. For example: if the student attended 2 days of a 20-day course and paid the application fee (150) and $750 tuition, the student would receive a refund of $310 (see example below). $950 Total fees Paid Minus $150 School application fee Minus $250 non-refundable tuition deposit Minus $150 Course supply Minus $90 ( 2 days received) ( $950/20 days) ($45/day) REFUND: $310 If the school cancels or discontinues a course, the school will make a full refund of all charges. Refunds will be paid within 30 days of cancellation or withdrawal. Students will be liable for any unpaid tuition fees that were accumulated by the student s attendance prior to withdrawal from the course. Any fees made towards attaining professional liability insurance for the student is non-refundable and is not included in refund calculation All refund requests must be made in writing by within 3 days of withdrawal. Please send all requests with your name, phone number, and class attended to: My signature below certifies that I have read, understood, and agreed to my rights and responsibilities and that the institution s cancellation and refund policies have been clearly explained to me. Student Name: Signature: Date: QuestNEC Representative Signature: Date: Quest Nursing Education Center 2135 Broadway Oakland, CA 94612

5 Admission Application Checklist Student Name: Signed Enrollment Application Filled out Eligibility Checklist Enclosed Fees (with selected payment plan) Signed Refund Policy Enclosed Copy of ID Quest Nursing Education Center 2135 Broadway Oakland, CA 94612

Emergency Medical Technician Course Application

Emergency Medical Technician Course Application Community Health Network Emergency Medical Technician Course Application July 2016 First day of Class July 11, 2016 EMERGENCY MEDICAL SERVICES & EDUCATION Thank you for your consideration in choosing Community

More information

Surgical Technician Program Application

Surgical Technician Program Application Contra Costa Medical Career College 4051 Lone Tree Way, Suite C Antioch Ca 94531 Phone (925) 757-2900 Fax( 925) 757-5873 Surgical Technician Program Application Date Name (First, MI, Last) Address City,

More information

Eastern Shore Community College Practical Nursing Program Application Packet 2015

Eastern Shore Community College Practical Nursing Program Application Packet 2015 Eastern Shore Community College Practical Nursing Program Application Packet 2015 The Eastern Shore Community College School of Practical Nursing was originally Northampton- Accomack Memorial Hospital

More information

Summa Center for EMS EMT Program Website: www.summa-ems.org Accreditation #324. Note that this course is limited to the first 20 applicants.

Summa Center for EMS EMT Program Website: www.summa-ems.org Accreditation #324. Note that this course is limited to the first 20 applicants. Enclosed is the application packet for the Fall 2015 EMT Course which begins on July 28 th and will be held on the Akron City Hospital Campus, Idabelle Firestone Center (School of Nursing). Note that this

More information

Nursing Assistant I Admission Requirements

Nursing Assistant I Admission Requirements Nursing Assistant I Admission Requirements 1. High School Diploma, GED or College Transcripts 2. Driver s License or State ID 3. Social Security Card 4. Physical Examination 5. Criminal Background Check

More information

Vocational Nursing Admission Procedures January 2015- May 2016

Vocational Nursing Admission Procedures January 2015- May 2016 Career & Technical Education Vocational Nursing Program (530) 841-5929 Fax (530) 841-5214 Vocational Nursing Admission Procedures January 2015- May 2016 The application period will begin August 11, 2014

More information

Student Name: Sex: Male{ } Female{ } Last First Middle Initial Address: Street Apt.# City State ZIP Code Home Phone: Work Phone: Cell phone:

Student Name: Sex: Male{ } Female{ } Last First Middle Initial Address: Street Apt.# City State ZIP Code Home Phone: Work Phone: Cell phone: VIP NURSING SCHOOL, Inc. 16388 East 14 th Street, San Leandro, California 94578 Office: (510) 481-0240; (510) 481-0360: Fax: (510) 481-0242 Web Site: www.vipnursing.net; Email: info@vipnursing.net Catalog

More information

Nurse Aide. Clinicals ** April 25 April 27, 2016 7:00 A.M. 3:00 P.M. or 6:00 A.M.-2:00 P.M.

Nurse Aide. Clinicals ** April 25 April 27, 2016 7:00 A.M. 3:00 P.M. or 6:00 A.M.-2:00 P.M. Nurse Aide January 11, 2016 February 11, 2016 5:00-9:00 P.M., Monday-Thursday Clinicals ** February 15 17, 2016 7:00 A.M. 3:00 P.M. or 6:00 A.M.-2:00 P.M. March 21, 2016 April 21, 2016 5:00-9:00 P.M.,

More information

RESPIRATORY THERAPY ASSOCIATE OF APPLIED SCIENCE APPLICATION FOR ADMISSION. Application Deadline MAY 1 ST

RESPIRATORY THERAPY ASSOCIATE OF APPLIED SCIENCE APPLICATION FOR ADMISSION. Application Deadline MAY 1 ST RESPIRATORY THERAPY ASSOCIATE OF APPLIED SCIENCE APPLICATION FOR ADMISSION Application Deadline MAY 1 ST EACH APPLICATION MUST INCLUDE THE FOLLOWING: o Application o Receipt of non-refundable $25 application

More information

NOTE: Immunization requirements are based on CDC recommendations for health care workers and Clinical site requirements.

NOTE: Immunization requirements are based on CDC recommendations for health care workers and Clinical site requirements. 4500 Steilacoom Blvd SW Lakewood WA 98499 www.cptc.edu Practical Nurse Application WE DO NOT HAVE A DEADLINE FOR APPLICATIONS. WE ARE FIRST COME FIRST SERVED. THE WAITLIST IS CURRENTLY GREATER THAN THREE

More information

Allan Hancock College 2016 Licensed Vocational Nursing Program Application Period: April 1 st June 30 th, 2015

Allan Hancock College 2016 Licensed Vocational Nursing Program Application Period: April 1 st June 30 th, 2015 *This application is for applicants who currently possess an LVN waitlist number* It is the students responsibility to have their COMPLETED application packet turned in to the Health Sciences Department

More information

Ghazvini Center for Healthcare Education 1528 Surgeons Drive Tallahassee, Florida 32308-4631 850.558.4500 phone

Ghazvini Center for Healthcare Education 1528 Surgeons Drive Tallahassee, Florida 32308-4631 850.558.4500 phone Ghazvini Center for Healthcare Education 1528 Surgeons Drive Tallahassee, Florida 32308-4631 850.558.4500 phone Nurse Assistant Program (HCP0122) Program Code 5024 120 hours of instruction Cost approximately

More information

SELECTION CRITERIA Completed packet (Refer to Page 2 Checklist) with FULL payment of fee to reserve class slot (First Come First Serve Basis)

SELECTION CRITERIA Completed packet (Refer to Page 2 Checklist) with FULL payment of fee to reserve class slot (First Come First Serve Basis) Certified Nursing Assistant Training Program Class Information Fall 2013 CLASS SCHEDULE TBA- Booneville - Monday & Thursday nights (5:00-9:00) TBA - Corinth - Monday & Thursday nights (5:00-9:00) TBA -

More information

PROGRAM TUITION DOWN PAYMENT. Patient Care Technician $3500 $2500. Pharmacy Technician $2500 $1500. Phlebotomy Technician $2300 $1300

PROGRAM TUITION DOWN PAYMENT. Patient Care Technician $3500 $2500. Pharmacy Technician $2500 $1500. Phlebotomy Technician $2300 $1300 APPLICATION INSTRUCTIONS AND CHECKLIST Please fill out the application completely. Then you can print and mail or bring it to Fast Track with your down payment. : PROGRAM TUITION DOWN PAYMENT Patient Care

More information

Patient Care Technician Program

Patient Care Technician Program Workforce and Continuing Education Division Patient Care Technician Program This program prepares a student to work as an entry-level patient care technician in a clinic, hospital, nursing home or long-term

More information

COST. CONTACT NEMCC Office of Continuing Education (662) 720-7296

COST. CONTACT NEMCC Office of Continuing Education (662) 720-7296 Certified Nursing Assistant Training Program Class Information Fall 2014 (Keep for your records) CLASS SCHEDULE September 8, 2014 - November 15, 2014 Booneville - Monday & Tuesday nights (5:30-9:30) September

More information

New Training Opportunity!

New Training Opportunity! New Training Opportunity! Certified Nursing Assistant (CNA) & Home Health Aide (HHA) Certified Nursing Assistant & Home Health Aide Training is an excellent training opportunity for individuals interested

More information

Application for Bachelor of Science in Nursing (BSN)

Application for Bachelor of Science in Nursing (BSN) Nicole Wertheim College of Nursing & Health Sciences 2 nd Floor Undergraduate Nursing, VBSN Program 11200 S.W. 8th Street, AHC3 Rm 232 Miami, FL 33199 Tel.: 305.348.4725 Fax: 305.348.7764 http://cnhs.fiu.edu/medictonurse

More information

PLEASE READ ALL OF THE ABOVE INFORMATION

PLEASE READ ALL OF THE ABOVE INFORMATION INFORMATION FOR THE CLASS OF 2016 Huntsville Memorial Hospital's Joe G. Davis School of Vocational Nursing is approved by the Texas Board of Nursing and the Texas Education Agency The program is a twelve

More information

NURSE ASSISTANT TRAINING Program Description www.redcross.org/hawaii. Georgette.demello@redcross.org (808) 739-8122

NURSE ASSISTANT TRAINING Program Description www.redcross.org/hawaii. Georgette.demello@redcross.org (808) 739-8122 NURSE ASSISTANT TRAINING Program Description www.redcross.org/hawaii Office Hours: Monday through Friday 8am to 4:30pm American Red Cross Nurse Assistant Training Office 4155 Diamond Head Road Honolulu,

More information

Nursing Program Application Packet. Fall 2015

Nursing Program Application Packet. Fall 2015 Nursing Program Application Packet Fall 2015 Submit all application materials to: Southwestern Oregon Community College Jade Stalcup 1988 Newmark Ave. Coos Bay, OR 97420 jstalcup@socc.edu 541-888-7443

More information

The University of Texas of the Permian Basin Bachelor of Science in Nursing (BSN) Admission Criteria

The University of Texas of the Permian Basin Bachelor of Science in Nursing (BSN) Admission Criteria 1 The University of Texas of the Permian Basin Bachelor of Science in Nursing (BSN) Admission Criteria 1. All students interested in applying for the Nursing Program must be admitted to the University

More information

SURGICAL TECHNOLOGY PROGRAM APPLICATION

SURGICAL TECHNOLOGY PROGRAM APPLICATION SURGICAL TECHNOLOGY PROGRAM APPLICATION Dear Applicant: Thank you for your interest in Wharton County Junior College s Surgical Technology Program. Information on the program and the requirements necessary

More information

Certified Nurse Aide Training Program Checklist and Application. Student Name: Campus Requested:

Certified Nurse Aide Training Program Checklist and Application. Student Name: Campus Requested: Certified Nurse Aide Training Program Checklist and Application Student Name: Campus Requested: Thank you for your interest in our Certified Nurse Aide Training Program! All applicants must follow these

More information

SPARTAN HEALTH SCIENCES UNIVERSITY

SPARTAN HEALTH SCIENCES UNIVERSITY APPLICATION FOR ADMISSION SPARTAN HEALTH SCIENCES UNIVERSITY SCHOOL OF NURSING SPARTAN DRIVE ST. JUDES HIGHWAY LA TOURNEY, VIEUX FORT ST. LUCIA, WEST INDIES PHOTO 2 X 2 Telephone: (758) 454-6128 Facsimile

More information

STUDENTS ARE RESPONSIBLE FOR THEIR OWN HEALTH INSURANCE

STUDENTS ARE RESPONSIBLE FOR THEIR OWN HEALTH INSURANCE Page 1 of 4 Date: Part A RN Student Reapplication to Program NORTH ARKANSAS COLLEGE Department of Nursing & Allied Health Programs Application for Admission LPN-RN-Associate Degree (AAS) Program Demographic

More information

NURSING. East Mississippi Community College P.O. Box 100 Mayhew, MS 39753 (662) 243-1910 2012-2013 PRACTICAL NURSING ADMISSION REQUIREMENTS

NURSING. East Mississippi Community College P.O. Box 100 Mayhew, MS 39753 (662) 243-1910 2012-2013 PRACTICAL NURSING ADMISSION REQUIREMENTS NURSING East Mississippi Community College P.O. Box 100 Mayhew, MS 39753 (662) 243-1910 2012-2013 PRACTICAL NURSING ADMISSION REQUIREMENTS Disclaimer The content and requirements of this admission packet

More information

Massachusetts Board of Registration in Pharmacy. Pharmacy Technician Registration Application

Massachusetts Board of Registration in Pharmacy. Pharmacy Technician Registration Application The Massachusetts Board of (Board) has contracted with Professional Credential Services (PCS) to process registration applications from pharmacy technicians. Applicants must submit all information directly

More information

Vocational Nursing Application Handbook Enrollment Policies and Application

Vocational Nursing Application Handbook Enrollment Policies and Application Merced College Vocational Nursing Application Handbook Enrollment Policies and Application Revised: September 2013 1 Table of Contents Admission Procedures for the Vocational Nursing Program Length of

More information

Associate Degree Nursing/Tech Prep Plan (Generic Student Curriculum)

Associate Degree Nursing/Tech Prep Plan (Generic Student Curriculum) Associate Degree Nursing/Tech Prep Plan (Generic Student Curriculum) Dear Associate Degree Nursing Applicant, Victoria College offers a two-year Associate of Applied Science degree in nursing. Upon successful

More information

ADMISSION TO THE MASSAGE THERAPY PROGRAM 2016

ADMISSION TO THE MASSAGE THERAPY PROGRAM 2016 Thank you for your interest in our Massage Therapy program. Caldwell Community College and Technical Institute is a co-educational college open to any individual meeting the admission requirements for

More information

Pharmacy Technician. Program Application Packet. Northeast Texas Community College is an equal opportunity, affirmative action, ADA institution.

Pharmacy Technician. Program Application Packet. Northeast Texas Community College is an equal opportunity, affirmative action, ADA institution. Pharmacy Technician Program Application Packet Pharmacy Tech Program APPLICATION Program description: This certificate program consists of 288 contact hours of lecture, lab and internship training for

More information

School of Nursing Application Packet for Admission to the RN to BSN Option

School of Nursing Application Packet for Admission to the RN to BSN Option School of Nursing Application Packet for Admission to the RN to BSN Option Please follow the steps outlined below to complete your application. A. To the Bellin Health Chief Nursing Officer, Laura Hieb,

More information

NURSING ASSISTANT PROGRAM REGISTRATION PACKET AND INFORMATION

NURSING ASSISTANT PROGRAM REGISTRATION PACKET AND INFORMATION NURSING ASSISTANT PROGRAM REGISTRATION PACKET AND INFORMATION Classes are offered at the following locations: Superstition Mountain Campus Signal Peak Campus Maricopa Campus Aravaipa Campus Spring Semesters

More information

Midland College. Licensed Vocational Nurse to Associate Degree Nursing Option. Admission Information

Midland College. Licensed Vocational Nurse to Associate Degree Nursing Option. Admission Information . Midland College Licensed Vocational Nurse to Associate Degree Nursing Option Admission Information The Associate Degree Nursing (A.D.N.) Program at Midland College is a one year program leading to an

More information

VOCATIONAL NURSING APPLICATION PROCEDURES

VOCATIONAL NURSING APPLICATION PROCEDURES VOCATIONAL NURSING APPLICATION PROCEDURES 1. Summit you VN application to the VN office at ITECC G 114. 2. Apply for college enrollment and financial aid at Oliveira Student Center as early as March for

More information

HEALTH CARE, CAREER AND TECHNICAL EDUCATION DIVISION ASSOCIATE IN APPLIED SCIENCE NURSING Associate Degree Nursing Program

HEALTH CARE, CAREER AND TECHNICAL EDUCATION DIVISION ASSOCIATE IN APPLIED SCIENCE NURSING Associate Degree Nursing Program HEALTH CARE, CAREER AND TECHNICAL EDUCATION DIVISION ASSOCIATE IN APPLIED SCIENCE NURSING APPLICATION CHECKLIST A. Submit an application to the Texas Southmost College, MEET REQUIREMENTS FOR ADMISSION,

More information

NURSING ASSISTANT TRAINING PROGRAM PROGRAM APPLICATION

NURSING ASSISTANT TRAINING PROGRAM PROGRAM APPLICATION ADMISSION STATUS ACCEPTED Finalized: DENIED Date: NURSING ASSISTANT TRAINING PROGRAM PROGRAM APPLICATION TONYA KENDRIX, MSN, MBA, HCM, RN PROGRAM DIRECTOR ABOUT THE PROGRAM The Nursing Assistant Training

More information

Continuing Education Allied Health Programs Certified Nurse Aide (CNA) - Student Requirements:

Continuing Education Allied Health Programs Certified Nurse Aide (CNA) - Student Requirements: Certified Nurse Aide (CNA) - Student Requirements: STAFF VERIFICATION: DATE: COMMENTS: Desired Class Date: _ Session: CEQ Name: Address: City:, Texas Zip: Phone #: Alt #: Email: Students entering the Certified

More information

Phlebotomy Technician Training Program Checklist and Application. Student Name: Campus Requested:

Phlebotomy Technician Training Program Checklist and Application. Student Name: Campus Requested: Phlebotomy Technician Training Program Checklist and Application Student Name: Campus Requested: Thank you for your interest in our Phlebotomy Technician Training Program! All applicants must follow these

More information

Visit us on the web for updated fees: http://www.sjpd.org/pdf_forms/permit_fees.pdf

Visit us on the web for updated fees: http://www.sjpd.org/pdf_forms/permit_fees.pdf MASSAGE PERMIT APPLICATION & PROCEDURES Visit us on the web for updated fees: http:///pdf_forms/permit_fees.pdf Applicant must complete, sign and submit an application to the Permits Unit and pay all required

More information

Ghazvini Center for Healthcare Education 1528 Surgeons Drive Tallahassee, Florida 32308-4631 850.558.4500 phone 850.558.4510 fax

Ghazvini Center for Healthcare Education 1528 Surgeons Drive Tallahassee, Florida 32308-4631 850.558.4500 phone 850.558.4510 fax Ghazvini Center for Healthcare Education 1528 Surgeons Drive Tallahassee, Florida 32308-4631 850.558.4500 phone 850.558.4510 fax Nurse Assistant Program (HCP0122) 120 hours of instruction $312.00 (in-state

More information

APPLICATION CHECKLIST

APPLICATION CHECKLIST HEALTH CARE, CAREER AND TECHNICAL EDUCATION DIVISION ASSOCIATE IN APPLIED SCIENCE - NURSING APPLICATION CHECKLIST A. Submit an application to the Texas Southmost College, MEET REQUIREMENTS FOR ADMISSION,

More information

COST. CONTACT NEMCC Office of Continuing Education (662) 720-7296

COST. CONTACT NEMCC Office of Continuing Education (662) 720-7296 Certified Nursing Assistant Training Program Class Information Spring 2016 (Keep for your records) CLASS SCHEDULE TBA --- Booneville - Monday & Thursday nights (5:30-9:30) February 11, 2016 --- Corinth

More information

HEALTH OCCUPATIONS PSYCHIATRIC TECHNICIAN PROGRAM APPLICATION PACKET

HEALTH OCCUPATIONS PSYCHIATRIC TECHNICIAN PROGRAM APPLICATION PACKET HEALTH OCCUPATIONS PSYCHIATRIC TECHNICIAN PROGRAM APPLICATION PACKET Applications will only be accepted during the posted application period for the semester you are applying for. Acceptance letters will

More information

RADIOLOGIC TECHNOLOGY PROGRAM ASSOCIATE IN APPLIED SCIENCE DEGREE INFORMATION AND ADMISSIONS PACKET

RADIOLOGIC TECHNOLOGY PROGRAM ASSOCIATE IN APPLIED SCIENCE DEGREE INFORMATION AND ADMISSIONS PACKET CENTRAL ARIZONA COLLEGE RADIOLOGIC TECHNOLOGY PROGRAM ASSOCIATE IN APPLIED SCIENCE DEGREE INFORMATION AND ADMISSIONS PACKET Superstition Mountain Campus Radiologic Technology Radiologic Technology is a

More information

APPLICATION FOR ADMISSION FALL 2015 GENERAL INFORMATION

APPLICATION FOR ADMISSION FALL 2015 GENERAL INFORMATION BACHELOR OF SCIENCE IN NURSING (RN-BSN Program) APPLICATION FOR ADMISSION FALL 2015 GENERAL INFORMATION 1. Transcripts: In order to be considered for admission to the RN-BSN program, all students must

More information

Frank Phillips College Vocational Nursing Department 1301 W. Roosevelt P.O. Box 5118 Borger, TX 79008 806-457-4200 ext. 746 www.fpctx.

Frank Phillips College Vocational Nursing Department 1301 W. Roosevelt P.O. Box 5118 Borger, TX 79008 806-457-4200 ext. 746 www.fpctx. Frank Phillips College Vocational Nursing Department 1301 W. Roosevelt P.O. Box 5118 Borger, TX 79008 806-457-4200 ext. 746 www.fpctx.edu KEEP THIS INFORMATION TO REMIND YOU OF NEEDED REQUIREMENTS. THE

More information

EL CENTRO COLLEGE CENTER FOR ALLIED HEALTH AND NURSING HEALTH OCCUPATIONS ADMISSIONS

EL CENTRO COLLEGE CENTER FOR ALLIED HEALTH AND NURSING HEALTH OCCUPATIONS ADMISSIONS EL CENTRO COLLEGE CENTER FOR ALLIED HEALTH AND NURSING HEALTH OCCUPATIONS ADMISSIONS PHYSICAL EXAMINATION AND IMMUNIZATION REQUIREMENTS In order to comply with the Texas Administrative Code (Title 25 Health

More information

South Arkansas Health Care Opportunity South Arkansas Community College Health Sciences Program Application

South Arkansas Health Care Opportunity South Arkansas Community College Health Sciences Program Application South Arkansas Health Care Opportunity South Arkansas Community College Health Sciences Program Application Phlebotomy/EKG Admission to South Arkansas Community College and the above listed Health Science

More information

Medical Assistant Training Program Checklist and Application. Student Name: Campus Requested:

Medical Assistant Training Program Checklist and Application. Student Name: Campus Requested: Medical Assistant Training Program Checklist and Application Student Name: Campus Requested: Thank you for your interest in our Medical Assistant Training Program! Please check the last page of this application

More information

2014-2016 TVCC/OCNE NURSING PROGRAM APPLICATION PACKET DIRECTIONS

2014-2016 TVCC/OCNE NURSING PROGRAM APPLICATION PACKET DIRECTIONS 2014-2016 TVCC/OCNE NURSING PROGRAM APPLICATION PACKET DIRECTIONS Thank you for your interest in Treasure Valley Community College (TVCC) Nursing Program. TVCC s nursing program is a member of the Oregon

More information

Licensed Practical Nursing Applications For the Fall 2016 Class

Licensed Practical Nursing Applications For the Fall 2016 Class Licensed Practical Nursing Applications For the Fall 2016 Class 1 Application for the Fall 2016 class should be completed and returned to Giles County Technology Center to be notified of the testing session

More information

SKILL CENTER PROGRAMMING NURSING ASSISTANT PROGRAM REGISTRATION PACKET AND INFORMATION

SKILL CENTER PROGRAMMING NURSING ASSISTANT PROGRAM REGISTRATION PACKET AND INFORMATION SKILL CENTER PROGRAMMING NURSING ASSISTANT PROGRAM REGISTRATION PACKET AND INFORMATION Classes are offered at the following location: Casa Grande Center 1015 E. Florence Blvd, A100 Casa Grande, AZ 85122

More information

Tuition: The cost for the program is $1438.25, which must be paid in full before course begins.

Tuition: The cost for the program is $1438.25, which must be paid in full before course begins. Ossining Extension Center Integrated Patient Care Technician Program Application Process 2014 The integrated patient care technician program (IPCT) is a 120-hour program designed to prepare Certified Nursing

More information

OAKLAND UNIVERSITY SCHOOL OF NURSING Instructions for completing the Clinical Health Requirements

OAKLAND UNIVERSITY SCHOOL OF NURSING Instructions for completing the Clinical Health Requirements OAKLAND UNIVERSITY SCHOOL OF NURSING Instructions for completing the Clinical Health Requirements Submission Deadline Dates for NEW Accelerated Second Degree and NEW Basic-BSN students Semester Admitted

More information

Dental Assisting Program

Dental Assisting Program Dental Assisting Program Dental Assistant [The Dental Assisting Program is a 200 Hour program that meets Monday, Tuesday, Wednesday, and Thursday evenings. The class time is 5:00pm 9:00pm.] Dental Assisting

More information

RADIOLOGIC TECHNOLOGY Uvalde Campus

RADIOLOGIC TECHNOLOGY Uvalde Campus Purpose RADIOLOGIC TECHNOLOGY Uvalde Campus The purpose of the Radiologic Technology program is to provide a quality education in Radiologic Technology and to prepare graduates to perform competently and

More information

STUDENT CERTIFIED NURSING ASSISTANT APPLICATION DETAILED INSTRUCTIONS

STUDENT CERTIFIED NURSING ASSISTANT APPLICATION DETAILED INSTRUCTIONS STUDENT CERTIFIED NURSING ASSISTANT APPLICATION DETAILED INSTRUCTIONS PHYSICAL EXAMINATION REPORT INSTRUCTIONS: The Physical Examination Report located at the end of this document must be completed by

More information

APPLICATION FOR ADMISSION

APPLICATION FOR ADMISSION APPLICATION FOR ADMISSION 1537 University Blvd., Morrilton, AR 72110 1-800-264-1094 www.uaccm.edu PERSONAL INFORMATION OFFICE USE ONLY I.D. 1. Last Name First Name Middle Int. Other Last Names Used 2.

More information

SAN JACINTO COLLEGE VOCATIONAL NURSING PROGRAM INFORMATION

SAN JACINTO COLLEGE VOCATIONAL NURSING PROGRAM INFORMATION North Campus South Campus 5800 Uvalde 13735 Beamer Rd. Allied Health Bldg., Room N-17.2112i Houston, Texas 77089 Houston, Texas 77049 281-484-1900 ext. 3504 or 3405 281-459-7114 Vocational.Nursing@sjcd.edu

More information

Lee College Student Application for Admission For Vocational Nursing (L.V.N.) Program

Lee College Student Application for Admission For Vocational Nursing (L.V.N.) Program Lee College Student Application for Admission For Vocational Nursing (L.V.N.) Program Type of complete in ink. (Immunizations must be submitted with application.) Desired DATE OF ENTRY into program: Semester

More information

Licensure by Examination Information For Graduates from Nursing programs within the United States

Licensure by Examination Information For Graduates from Nursing programs within the United States 17938 SW Upper Boones Ferry Road Portland, Oregon 97224-7012 Licensure by Examination Information For Graduates from Nursing programs within the United States Non-United States Graduate: If you studied

More information

TMCC NURSING PROGRAM APPLICATION FOR 2015-2016 FALL ADMISSION

TMCC NURSING PROGRAM APPLICATION FOR 2015-2016 FALL ADMISSION Nursing students are candidates selected for admission into the nursing program of study. The application process for admission into the Associate of Applied Science Practical Nursing Program must be completed

More information

Criminal Justice Institute

Criminal Justice Institute May 22, 2014 Dear Student: Thank you for your interest in obtaining your Florida certification as a law enforcement or correctional officer. The Equivalency-of-Training process enables one to become exempt

More information

UACTI EMT Program Application Information:

UACTI EMT Program Application Information: UACTI EMT Program Application Information: Tuition for the EMT program is $925 plus a $25.00 nonrefundable application fee. Tuition includes a uniform shirt and textbook. Tuition also includes the student

More information

Nurse Aide Certification Program and Patient Care Technician, Part Three Registration Packet

Nurse Aide Certification Program and Patient Care Technician, Part Three Registration Packet Nurse Aide Certification Program Brookhaven College Workforce Continuing Education Division COVER SHEET Prepare for the nurse aide certification examination with this course addressing both written clinical

More information

Recruit Application Fire Academy

Recruit Application Fire Academy Recruit Application Fire Academy Applicant Name: Street Address: Daytime telephone: Desired Class: Fire Fighter I & II Notification of Social Security Number Collection and Usage In compliance with FL

More information

California Escrow Association

California Escrow Association The has developed the attached documentation package in an effort to bring uniformity to the Escrow I, Escrow II and Escrow III courses presented by entities other than a university, college or community

More information

Division of Continuing Education and Community Services Application for Nurse Assistant Course CNA APPLICATION CHECK LIST

Division of Continuing Education and Community Services Application for Nurse Assistant Course CNA APPLICATION CHECK LIST CNA APPLICATION CHECK LIST Applicant Name: Phone No: Alternative No: Application Date: Please submit this information to WCCC as soon as possible. You will not be eligible to start classes if we do not

More information

Ossining Extension Center

Ossining Extension Center NON-CREDIT HEALTHCARE APPLICATION Ossining Extension Center Arcadian Shopping Center, Route 9 Ossining, NY 10562 Certified Nursing Assistant RN Refresher Mental Health Technician Home Health Aide Patient

More information

VOCATIONAL NURSING PROGRAM 2015-2017

VOCATIONAL NURSING PROGRAM 2015-2017 SUTTER COUNTY SUPERINTENDENT OF SCHOOLS REGIONAL OCCUPATIONAL PROGRAM VOCATIONAL NURSING PROGRAM 2015-2017 Sutter County One Stop 950 Tharp Road, Building 1000, Yuba City, CA 95993 (530)822-5120 TTY (530)822-5104

More information

Central Campus: Application for ADN-RN Program

Central Campus: Application for ADN-RN Program Central Campus Application for ADN-RN Program This application and this checklist must be filled out completely and submitted to the Associate Degree Nursing Department you have selected during the application

More information

Delgado PHYSICAL THERAPIST ASSISTANT PROGRAM

Delgado PHYSICAL THERAPIST ASSISTANT PROGRAM Delgado COMMUNITY COLLEGE PHYSICAL THERAPIST ASSISTANT PROGRAM APPLICATION PACKET Spring, 2016 The Delgado Community College Physical Therapist Assistant (PTA) Program is accredited by the Commission on

More information

Advanced College International Language Office

Advanced College International Language Office Advanced College International Language Office Dear Sir or Madam: We are pleased to send you information about the International Language Office (ILO) at Advanced College. The ILO offers a variety of programs

More information

NURSING ASSISTANT PROGRAM INFORMATION AND

NURSING ASSISTANT PROGRAM INFORMATION AND CENTRAL ARIZONA COLLEGE SKILLS CENTER HEALTHCARE PROGRAMS NURSING ASSISTANT PROGRAM INFORMATION AND ENROLLMENT PACKET One-Stop / Skills Center Job Skills Training Program SkillsCenter6/2008 Central Arizona

More information

MATC PRACTICAL NURSING (PN) PROGRAM

MATC PRACTICAL NURSING (PN) PROGRAM MATC PRACTICAL NURSING (PN) PROGRAM MOUNTAINLAND APPLIED TECHNOLOGY COLLEGE A Utah College of Applied Technology Campus SPRING 2016 P R AC TI C AL N U R S I NG AP P LI C ATI O N P AC KE T S P R I NG 2

More information

Surgical Technology Program Directions for Completing the Application 2013-2014

Surgical Technology Program Directions for Completing the Application 2013-2014 Surgical Technology Program Directions for Completing the Application 2013-2014 Thank you for applying to the Surgical Technician program at the Ossining Extension Center of Westchester Community College.

More information

MATC PHARMACY TECHNICIAN PROGRAM

MATC PHARMACY TECHNICIAN PROGRAM MATC PHARMACY TECHNICIAN PROGRAM MOUNTAINLAND APPLIED TECHNOLOGY COLLEGE American Fork Orem Spanish Fork Thanksgiving Point Wasatch FALL 2015 Pharmacy Technician Program Mountainland Applied Technology

More information

February 6 May 21 (no class March 26) Saturdays 9am-1pm Location: UConn Health Center Fee: $949 plus text and $35 administrative fee

February 6 May 21 (no class March 26) Saturdays 9am-1pm Location: UConn Health Center Fee: $949 plus text and $35 administrative fee Central Sterile Processing Technician Spring 2016 Program Information: This 15-week program covers anatomy and physiology; microbiology and infection control; decontamination and sterilization processing;

More information

DENTAL ASSISTANT PROGRAM PROGRAM REQUIREMENT PACKET

DENTAL ASSISTANT PROGRAM PROGRAM REQUIREMENT PACKET DENTAL ASSISTANT PROGRAM PROGRAM REQUIREMENT PACKET 4500 Steilacoom Blvd SW Lakewood, WA 98499 www.cptc.edu DENTAL ASSISTANT APPLICATION PLEASE REFER TO THESE PAGES FOR INFORMATION REGARDING THE ADMISSION

More information

Admission Policies (This language replaces the Admission Policies on pages 8-9)

Admission Policies (This language replaces the Admission Policies on pages 8-9) Campuses: Bellevue, KY; Madisonville, KY; Owensboro, KY; Online Daymar College Catalog 2014 2015 Addendum Admission Policies (This language replaces the Admission Policies on pages 8-9) Admission Procedures

More information

Ukiah Adult School CNA Program 1056 North Bush Street Ukiah, CA 95482 707/463-5217 APPLICATION PACKET

Ukiah Adult School CNA Program 1056 North Bush Street Ukiah, CA 95482 707/463-5217 APPLICATION PACKET Ukiah Adult School CNA Program 1056 North Bush Street Ukiah, CA 95482 707/463-5217 APPLICATION PACKET For Certified Nurse Assistant Training Program Length of Program: 5 weeks Days of Program: Monday through

More information

Student Application Forms 2015-2016. P a g e 1

Student Application Forms 2015-2016. P a g e 1 Department of PHARMACY TECHNICIAN Student Application Forms 2015-2016 P a g e 1 P a g e 2 Dear Prospective Student: Thank you for your interest in the Pharmacy Technician Program at San Jacinto College

More information

PHARMACY TECHNICIAN PROGRAM APPLICATION

PHARMACY TECHNICIAN PROGRAM APPLICATION PHARMACY TECHNICIAN PROGRAM APPLICATION Admission Requirements Completed application must be turned in to the Public Service Careers (PSC) Building, across the street from the main campus, prior to registering

More information

SURGICAL TECHNOLOGY PROGRAM APPLICATION

SURGICAL TECHNOLOGY PROGRAM APPLICATION SURGICAL TECHNOLOGY PROGRAM APPLICATION Dear Applicant: Thank you for your interest in Wharton County Junior College s Surgical Technology Program. Information on the program and the requirements necessary

More information

COMPUTED TOMOGRAPHY CERTIFICATE PROGRAM

COMPUTED TOMOGRAPHY CERTIFICATE PROGRAM 1 School of Health Professions COMPUTED TOMOGRAPHY CERTIFICATE PROGRAM APPLICATION PACKET University System of Georgia An Affirmative Action/Equal Opportunity Institution 2 Dear Applicant, Thank you for

More information

Oregon Coast Community College Medical Assistant Program Application 2015-2016 Academic Year Deadline: December 4, 2015

Oregon Coast Community College Medical Assistant Program Application 2015-2016 Academic Year Deadline: December 4, 2015 Oregon Coast Community College Medical Assistant Program Application 2015-2016 Academic Year Deadline: December 4, 2015 Program Description The Oregon Coast Community College Medical Assistant Program

More information

Proposed Method of Payment: Self Pay VA Assistance Financial Aid Bright Futures Florida Prepaid Paid Agency Sponsor/Agency Name:

Proposed Method of Payment: Self Pay VA Assistance Financial Aid Bright Futures Florida Prepaid Paid Agency Sponsor/Agency Name: Recruit Application Applicant Name: Street Address: Daytime telephone: Cell phone: E-Mail : @ Sex: Race: Social Security #: BAT Score: Desired Class: Law Enforcement Basic Recruit Program (Day Class) Law

More information

The Radiologic Science Program at the College of Coastal Georgia

The Radiologic Science Program at the College of Coastal Georgia The Radiologic Science Program at the College of Coastal Georgia Page 1 of 7 Instructions 1. Complete a College of Coastal Georgia Application. (May be obtained from the Registrar s Office) Return the

More information

Pharmacy Technician Program. Pharmacy Technician. Program Application Packet. Health Professions Division

Pharmacy Technician Program. Pharmacy Technician. Program Application Packet. Health Professions Division Pharmacy Technician Program 12800 Abrams Road Dallas, Texas 75243-2199 972.238.6950 www.richlandcollege.edu/hp Health Professions Division Pharmacy Technician Program Application Packet Equal Opportunity

More information

COAHOMA COMMUNITY COLLEGE SHORT-TERM CERTIFICATE PROGRAMS Application & Admission Procedure

COAHOMA COMMUNITY COLLEGE SHORT-TERM CERTIFICATE PROGRAMS Application & Admission Procedure COAHOMA COMMUNITY COLLEGE SHORT-TERM CERTIFICATE PROGRAMS Application & Admission Procedure Please choose the program you are applying for: o Phlebotomy Spring 2016 Page 1 General Information (There is

More information

Adult Patient Care Technician (PCT)

Adult Patient Care Technician (PCT) Updated 8-29-2013 Adult Patient Care Technician (PCT) 2014-2015 Main Campus North Campus East Campus 6305 SR 70 801-9thST. W. 5520-Lakewood Ranch Blvd. Bradenton, FL 34203 Palmetto, FL 34221 Bradenton,

More information

APPLICATION FOR ADMISSION BETHEL UNIVERSITY DEPARTMENT OF NURSING RN to BSN

APPLICATION FOR ADMISSION BETHEL UNIVERSITY DEPARTMENT OF NURSING RN to BSN Please indicate date you are seeking to enroll in the nursing program. Session/Month PERSONAL DATA Social Security Number ------ Full Legal Name Last First MI Maiden Shipping Mailing Address City State

More information

VOCATIONAL NURSING PROGRAM

VOCATIONAL NURSING PROGRAM 2013-2014 Application for admission to: VOCATIONAL NURSING PROGRAM PLEASE SPECIFY WHICH CAMPUS SITE(S) YOU WISH TO APPLY BY RANKING EACH IN ORDER OF PREFERENCE: Cuero Gonzales Hallettsville Victoria PLEASE

More information

Imperial Valley College Licensed Vocational Nursing Program Pre-Application Packet

Imperial Valley College Licensed Vocational Nursing Program Pre-Application Packet Imperial Valley College offers a Vocational Nursing Program for students who are in good health, over 18, and eligible for admission. The program prepares graduates to provide basic bedside nursing care

More information

APPLICATION FOR ADMISSION PHARMACY TECHNICIAN PROGRAM DIXIE APPLIED TECHNOLOGY COLLEGE

APPLICATION FOR ADMISSION PHARMACY TECHNICIAN PROGRAM DIXIE APPLIED TECHNOLOGY COLLEGE APPLICATION FOR ADMISSION PHARMACY TECHNICIAN PROGRAM DIXIE APPLIED TECHNOLOGY COLLEGE You must apply for formal admission to the Pharmacy Technician Program at the Dixie Applied Technology College (DXATC).

More information

Pierpont Community & Technical College School of Health Careers Practical Nursing Program

Pierpont Community & Technical College School of Health Careers Practical Nursing Program Pierpont Community & Technical College School of Health Careers Practical Nursing Program ADMISSION PROCESS 1. Complete and submit Pierpont Community & Technical College application including: a. Submit

More information

DENTAL ASSISTANT PROGRAM PROGRAM REQUIREMENT PACKET

DENTAL ASSISTANT PROGRAM PROGRAM REQUIREMENT PACKET DENTAL ASSISTANT PROGRAM PROGRAM REQUIREMENT PACKET 4500 Steilacoom Blvd SW Lakewood, WA 98499 www.cptc.edu DENTAL ASSISTANT APPLICATION PLEASE REFER TO THESE PAGES FOR INFORMATION REGARDING THE ADMISSION

More information

DEADLINE DATES SUBMITTING YOUR APPLICATION DISCLAIMER FRANKFORD HOSPITAL SCHOOL OF NURSING APPLICATION FOR ADMISSION

DEADLINE DATES SUBMITTING YOUR APPLICATION DISCLAIMER FRANKFORD HOSPITAL SCHOOL OF NURSING APPLICATION FOR ADMISSION FRANKFORD HOSPITAL SCHOOL OF NURSING APPLICATION FOR ADMISSION 4918 Penn Street Philadelphia, PA 19124 Phone (215) 831-6740 x124 Fax (215) 831-6732 http://www.frankfordhospitals.org/nursing INSTRUCTIONS

More information