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.
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 $45. 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:*
Course Option (choose one)*

Nurse Aide IBLS CPR Health Care ProviderMedical AssistantPhlebotomy TechnicianNurse Aide I RefresherAdvance Nurse Aide + PhlebotomyOnline Medical Billing & Coding

All students must pay a registration fee for course entry.*

Nurse Aide I or Nurse Aide Refresher (non refundable)Non-Refundable Registration Fee

$50.00 Quantity

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

$625.00 Quantity

BLS CPR Health Care ProviderNon-Refundable Registration Fee

$55.00 Quantity

Medical Assistant or Advance Nurse Aide 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 TechnicianFull Tuition Payment: Only if you opt out of the payment plan.

$700.00

Phlebotomy TechnicianNon-Refundable Registration Fee

$75.00

Online Medical Billing & Coding Non-refundable Registration Fee

$100.00 Quantity

Online Medical Billing & Coding Full Tuition Payment: Only if you opt out of payment plan.

$1,250.00 Quantity

Enter coupon

Total

$0.00

Tuition Only Payment Method Options (CHOOSE ONE)*

AFTERPAY (Invoice will be sent to email)Payment 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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Payment Methods

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First Name

Last Name

Credit Card Number

Card Expiration

Security Code

Please click one of the PayPal options to complete payment and submit the form.

Student Registration Form