Ava Enrollment Form

Ava Enrollment Form
Select your course and date *
Individual Course Cost: $800

Patient Care Technician Course Cost: $3500
Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Date of Birth *

Month Day Year
Date
Email *
example@example.com
Note: If you choose Down payment today, the remaining payments should be made in the office. You can establish a weekly or biweekly payment plan for the remaining amount due.

My Products *

Individual Course - Pay in Full $ 800.00

Individual Course - Down Payment $ 200.00

Patient Care Technician Course - Pay In Full $ 3,500.00

Patient Care Technician Course - Down Payment $ 500.00

Total $ 0.00