Seminar Enrollment Agreement

Seminar Enrollment Agreement
School Name: Align Health Careers Institute, LLC

Address: 2080 N. Hwy. 360 #385

City: GRAND PRAIRIE State: TEXAS Zip: 75050

Telephone: (469) 984-6203 E-mail Address: ALIGNHEALTHCAREERS@GMAIL.COM
Student Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Please enter a valid phone number.
Last Four Digits of Social Security Number *Enter in the format: 6789*
The last four digits of your Social Security Number are required solely for official internal student identification and accurate record-matching purposes. We ensure all collected data is handled securely.
Email*
example@example.com
Date of Birth*

MonthDayYear
Date

Student Information