Continuing Education Health Classes Registration |

CLASS LIST
- Dialysis Technician
- Nurse Assistant I/II
- Medication Aide
- Medical Assistant
- Pharmacy Technician
- Phlebotomy Technology
- Fast Forward Class In Pharmacy Technician
- Emergency Medical Technician (EMT)
- Anatomy & Physiology for EMS Providers (EMS 3000)
- BLS for HealthCare Providers (CPR)
Dialysis Technician
- Dialysis Technician 6:00 pm-10:00 pm T,TH 2/13/20 - 6/9/20 $216.50
Nurse Assistant I/II
- NUR-3240 Nurse Assistant I 9:00 am-1:00 pm M,T,W,TH 1/27/20 - 4/22/20 $216.50
- NUR-3240 Nurse Assistant I 9:00 am-1:00 pm M,T,W,TH 5/13/20 - 8/13/20 $216.50
- NUR-3240 Nurse Assistant I 6:00 pm-10:00 pm M,W 1/13/20 - 6/6/20 $216.50
- NUR-3241 Nurse Assistant II 1:30 pm-5:30 pm T,TH 1/7/20 - 5/18/20 $216.50
Medication Aide
- PHM-4100 Medication Aide for Skilled Living 6:00 pm-10:00 pm T 2/11/20 - 3/24/20 $126.50
- PHM-4100 Medication Aide for Skilled Living 6:00 pm-10:00 pm T 6/16/20 - 7/28/20 $126.50
- PHM-4100 Medication Aide for Assisted Living 1:30 pm-5:30 pm T,TH 2/4/20 - 2/25/20 $126.50
- PHM-4100 Medication Aide for Assisted Living 9:00 am-1:00 pm TH 4/2/20 - 5/14/20 $126.50
- PHM-4100 Medication Aide for Assisted Living 6:00 pm - 10:00 pm TH 7/9/20 - 8/20/20 $126.50
Medical Assistant
- Medical Assistant 6:00 pm - 10:00 pm T,TH 2/4/20-TBA $216.50
Pharmacy Technician
- PHM-3250 Pharmacy Tech 1:30 pm-5:30 pm M,W 1/13/20 - 6/8/20 $181.50
- PHM-3250 Pharmacy Tech 6:00 pm-10:00 pm M,W 5/14/20 - 9/29/20 $181.50
- PHM-3250 Pharmacy Tech-hybrid 7:00 pm-10:00 pm Class will meet on 1/28, 3/31, 6/9 1/28/20 - 6/9/20 $181.50
Phlebotomy Technology
- MLA-PHLE Phlebotomy Tech-seated 6:00 pm-10:00 pm M,W 1/13/20 - 7/29/20 $181.50
- MLA-PHLE Phlebotomy Tech hybrid 6:00 pm-10:00 pm W 1/15/20 - 7/29/20 $181.50
Fast Forward Class In Pharmacy Technician
- Pharmacy Technician – Hybrid: 12/9/19 – 1/21/20 Face to Face Meetings: 12/9, 1/2, 1/21 6:00 pm – 10:00 pm - $181.50
Emergency Medical Technician (EMT)
- Jan 7 – May 12 - Tue & Thur nights 6-10pm and some Saturdays 8-5pm - $180 registration + $16.50 insurance
Anatomy & Physiology for EMS Providers (EMS 3000)
- Jan 6 – March 15, 2020 - $125 registration
BLS for HealthCare Providers (CPR)
- Jan 28, Feb 25, March 24, April 28 1-6pm - $60 registration
SSN OR STUDENT ID NUMBER:*
FULL NAME:*
First Middle Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
EMAIL ADDRESS:*
HOME PHONE:*
BIRTH DATE: Month:*
Date Format: MM slash DD slash YYYY
ARE YOU HISPANIC/LATINO?
- NO (NHS)
- YES (HIS)
RACE (Check one)
- White
- Black/African American
- Native American/Alaska Native
- Asian
- Hawaiian/Pacific Islander
SEX (Check one):
- Male
- Female
EMPLOYMENT STATUS (Check one):
- Retired
- Unemployed-Not Seeking
- Unemployed-Seeking
- Full time
- Part-Time--Number of Hours Per Week
No. of hours
EDUCATION LEVEL (Check only one):
- Completed High School
- Adult High School Diploma
- GED Diploma
- One-Year Vocational Diploma
- Associate Degree
- Bachelor's Degree
- Master's Degree
- OR -Highest Grade Completed
Grade
CITIZENSHIP (Check one):
- U.S Citizen
- Permanent Resident Alien
- Non-Immigrant Alien
- Other
Name of Employer
STUDENT SIGNATURE:
Date
Date Format: MM slash DD slash YYYY
Certification of Accuracy*
By this check, I certify that the information I have given is true and complete to the best of my knowledge. I further understand that falsification or failure to supply the correct information may be considered grounds for rejection or dismissal. Further, I understand that by submitting this information via electronic transmission that I acknowledge the above statement of certification in lieu of a signature.
Please check:
- Yes

Continuing Education Health Classes Registration

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