GDEI 2024 ORIENTATION

1
Full Legal Name* This field is required.What is the correct spelling of your name for your diploma?
First Name
Last Name
2
What is your date of birth?* This field is required.
Date
Month
Day
Year
3
Current Age* This field is required.
4
Email Address* This field is required.What is a reliable email address for you to receive important information?
example@example.com
5
How did you learn about our program? Please include the name of source.* This field is required.
6
Have you/will you gathered all documents required for enrollment? (High-school Diploma, Drivers License, Application, Immunization Record. Please be prepared to re-submit enrollment documents as part of the first orientation assignment located in the student portal.)* This field is required.
YESNO
7
Our classes are held on Fridays at 9:00 a.m. until 5:00 p.m. Will this be a problem for your current schedule?* This field is required.
YESNO
8
Are you currently employed?* This field is required.
YESNO
9
Would you prefer to have a optional graduation ceremony or just receive your degree?
Graduation Ceremony ($150)
Certification Only (Free)
10
Graduation Option * This field is required.Please select your graduation option after completion of program.
Please Select
Please Select
Graduation Ceremony ($150)
Certification Only (Free)
11
GDEI Uniform* This field is required.Please select your size choice by using the dropdown field below.
Please Select
Please Select
Small
Medium
Large
XL
XXL
XXL
Dental Scrubs
Please Select
Please Select
Small
Medium
Large
XL
XXL
GDEI T-Shirt
Please Select
Please Select
Small
Medium
Large
XL
XXL
GDEI Lab Coat
12
What size do you wear in GDEI dental scrubs?
Small
Medium
Large
XL
XXL
XXXL
13
What size do you wear in GDEI T-Shirts?
Small
Medium
Large
XL
XXL
XXXL
14
What size do you wear in GDEI Lab Coats?
Small
Medium
Large
XL
XXL
XXXL
15
We require all students to provide negative covid test results (VAILID ONLY TWO DAYS PRIOR TO ORIENTATION). Will this be a problem for you?* This field is required.At home Covid test results are accepted. Tests can be provided at the school for $25.
YESNO
16
Which Vaccinations have you had previously? Select all that apply.* This field is required.(Please be prepared to have a copy of your immunization records to upload on the class portal as part of the orientation assignment.)
HPV
HEP A
HEP B
HEP C
TB TEST
Coronavirus
MEASLES, MUMPS & RUBELLA
FLU SHOT
17
What do you hope to learn from this program?* This field is required.
18
Any additional information/questions that you need to inform administration of may be placed here.* This field is required.
Should be Empty: