EHC Health Career Institute

EHC Health Career Institute
Student Registration Form

Fill out this form in its entirety for registration.
Name *

First NameLast Name
Email *
example@example.com
Phone Number *
Please enter a valid phone number.Format: (000) 000-0000.
Date Of Birth *

MonthDayYear
Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Gender *
Highest Grade Completed *
Current Employer/Job Title *
If you are ordering scrubs from EHC for $50. Please let us know what size top blanks and size bottoms blank you need. Our vendor will be at orientation.
Type in Class Start Date & Day or Evening Class:*
Program Option (choose one)*
All students must pay a registration fee for course entry.*
Categories:All

All
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Nurse Aide I, Nurse Aide Refresher, Medication Aide, EKG Technician, Advance Nurse Aide+Med. Aide (non refundable)
Non-Refundable Registration Fee

$50.00 Quantity



Nurse Aide I
Full Tuition Payment...Only if you opt out of payment plan.

$725.00 Quantity



BLS CPR Health Care Provider
Non-Refundable Registration Fee

$60.00 Quantity



Medical Assistant or Advance Nurse Aide+Phlebotomy
Non-Refundable Registration Fee

$100.00 Quantity



Medical Assistant
Full Tuition Payment: Only if you opt out of payment plan. Refund Per Policy

$1,999.00 Quantity



Phlebotomy Technician
Full Tuition Payment: Only if you opt out of the payment plan.

$700.00



Phlebotomy Technician
Non-Refundable Registration Fee

$75.00



Medication Aide
Full Tuition Payment: Only if you opt out of payment plan.

$325.00 Quantity



Advance Nurse Aide + Med Aide
Full Tuition Payment: Only if you opt out of payment plan.

$850.00 Quantity



EKG Technician
Full Tuition Payment: Only if you opt out of payment plan.

$579.00 Quantity



TB Skin Test
$45.00 Quantity



Subtotal

$0.00

Tax

$0.00

Total

$0.00
Veterans Admin. GI BillPayment Plan offered by EHC Health Career InstituteMeritize (Medical Assistant Only)
NON REFUNDABLE APPLICATION FEE REQUIRED TO PROCESS THIS APPLICATION. I am an authorized user of the card entered to pay the NONREFUNDABLE registration fee and will NOT dispute the payment with my credit/debit card institution; so as long as the transaction corresponds to the terms indicated in this form. (Please type YOUR NAME in the box below) *

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