Enrollment Application

Student Details:

Full Name*

First NameLast Name

Phone Number*

E-mail

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Select your program of study from the options below:

Phlebotomy TechnicianFor HealthCare Professionals

$275.00 Quantity
Item subtotal:$0.00

Phlebotomy Trainer

$300.00 Quantity
Item subtotal:$0.00

National Phlebotomy Exam Preparation Course

$75.00 Quantity
Item subtotal:$0.00

Hardcopy Certificate If you would like a hardcopy in addition to the digital copy of your certification add this option to your cart.

$20.00 Quantity

Total

$0.00

Credit Card Details (Course fees are non-refundable)
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Upload any required documents for your selected program of study:

ONCE YOUR APPLICATION HAS BEEN REVIEWED, ONE OF OUR ACADEMIC ADVISORS WILL REACH OUT TO YOU AND EXPLAIN THE POST-REGISTRATION PROCESS. YOU WILL BE PROVIDED WITH A LOG IN TO THE CANVAS PORTAL, WHERE YOU WILL FIND THE COURSE MATERIALS.

(THE REVIEW PROCESS CAN TAKE UP TO 24 HOURS. INSTRUCTIONS TO ACCESS THE COURSE WILL BE SENT TO THE EMAIL PROVIDED DURING REGISTRATION.)