Mission of Hope International Inc
9100 Southwest Freeway, Suite #135, Houston, Tx 77074 ; Phone: 713-482-1030 ; Email: mhitrainingcenter@gmail.com ; Fax: 281-34331824
Medical Assistant Registration Form
Student First Name
*
Student Middle Name
Student Last Name
*
Date of Birth
*
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Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Social Security Card
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Copy of Driving License
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High School Diploma or Highest Level of Education
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Medical Assistant Program
Tuition is $4400 for the course, 11 months program. 11 monthly payment of $400. One Time Registration Fee of $100
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One Time Registration Fee
$
100.00
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Full Tuition Payment
$
4,400.00
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Payment Plan- 11 Monthly Payment of $400
$
400.00
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Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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