ACERTA Registration Form

Enrollment Form

Welcome to ACERTA! This enrollment form is your first step toward building skills, earning certifications, and advancing your career in healthcare, technology, business, and digital fields. Please complete the form to secure your spot. Once submitted, you will receive your next steps and access details by email. We’re excited to support you on your career journey.
Participant Information

Please provide the following basic information. This data is essential for creating your secure account, issuing official documents, and ensuring clear communication throughout your enrollment. All fields are required unless marked otherwise.
Name*

First NameLast Name
Email Address*
Phone Number*
Please enter a valid phone number.
Have you previously taken a Medical Coding Course?*

YesNo
If yes, what where or what course?
Current Residence Information

Enter your complete current address below. This ensures we can send you essential course materials and official documentation promptly and accurately.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Residence Information (if different from above)

For Applicants under 18 years of age
Name

First NameLast Name

Email*
example@example.com
ACERTA Course Selections

Please select the ACERTA course or program you wish to enroll in. Be sure to choose the option that best aligns with your career goals and current skill level. Your selection helps us prepare your enrollment and learning access accurately.
Which course are your interested in?*

ACERTA Course Selections