EHC Health Career Institute

EHC Health Career Institute
Student Registration Form

Fill out this form in its entirety for registration. Please check program schedule before registering for any of our classes.
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.
Program Location (choose one)
Program Option (choose one)
Type in Class Start Date & Day or Evening Class:
All students must pay a registration fee for course entry. If you are opting for the payment plan. ONLY pay registration fee for the program chosen.
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
Tuition Only Payment Method Options (CHOOSE ONE)
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)

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

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