ADMISSION FORM

Address*

Street Address

Street Address Line 2

CityState

Zip Code
Course Information
Course/Program*
Academic Year*
Month Enrolled*
Admission Date *

MonthDayYear
Start Date *

MonthDayYear
Projected End Date *

MonthDayYear
Tuition Cost ($)*
Student Documents A*

Upload File (Please attach a copy of your ID)
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Student Documents B*

Upload File (Please attach a copy of your ID and Nurse Aide Certificate)
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Student Documents C*

Upload File (Please attach a copy of your ID & High School Certificate or GED, or Degree)
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Date Signed *

MonthDayYear
Student Signature*

Clear
School Administration Dept.

For official use only
Application Status
Student Code
Course Status
Completion Date

MonthDayYear
Certificate Earned
Certificate Issue Date

MonthDayYear
Employment Status Year 1
Employment Status Year 2
Employment Status Year 3
School Adminstrator
G-Note
Student tasks & Notes: