Seminar Enrollment Agreement

Course and Course Cost
Please select the seminar you wish to enroll in (SELECT ONE)*

IV Therapy Seminar Contact Hours 3.5 Cost $350.00Phlebotomy Seminar Contact Hours 3.5 Cost $350.00Nursing Assistant Seminar Contact Hours 24 Cost $625.00
*Fee is estimated and based on current cost and subject to change.
Method of Payment (Check One)*

Money OrderCashier CheckCashOther
Approved and regulated by the Texas Workforce Commission, Career Schools and Colleges, Austin, Texas.

Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge.

If this application leads to enrollment, I understand that false or misleading information in my application or interview may result in my release.
Printed Name*

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Signature*

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Date*

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Student Information