Student Enrollment Form

LOTUS HEALTHCARE ACADEMY

Phlebotomy Program Enrollment Form
SECTION 1: PERSONAL INFORMATION
Name

First NameLast Name
Date Of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Social Security Number:
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Select Program Schedule
Important

Please select only ONE cohort. Your application and seat reservation will be processed based on the cohort selected below.
Select Your Cohort (Day or Evening Program)
Select Your Cohort (Weekend Program)
CPR/BLS Certification (Optional Add-On)

Most healthcare employers require CPR certification. Lotus Healthcare Academy offers American Heart Association CPR/BLS training for an additional $75. If you would like to include this certification, select the CPR add-on during checkout when submitting your seat deposit or full tuition payment.
Would you like to add CPR/BLS Certification to your enrollment for $75?
SECTION 2: EDUCATION BACKGROUND
High School Diploma or Equivalent? A transcript showing proof of high school completion or higher education must be provided. if not submitted at the time of enrollment, it is expected on the first day of class.
Name Of School/Institution
Enrollment Policy:

To maintain small cohort sizes and structured hands-on lab instruction, enrollment is confirmed upon receipt of payment.
How do you plan to pay for this program?
Using a Buy Now, Pay Later option? Please Read.

Buy Now, Pay Later options are available at checkout and may appear after selecting your payment method. Select "Pay without Link" to view additional payment options, including Afterpay and installment plans. Approval decisions are made instantly by the payment provider and are not guaranteed. Students using this option, are not required to pay a seat deposit. If you are not approved, you may return to this page and select the $150 seat deposit option to secure your seat. Remaining balance is due per payment schedule. Enrollment is confirmed once payment has been successfully processed.
A $150 deposit secures your seat in the program

The deposit is applied toward total tuition

Students paying the tuition in full or using third party financing are not required to submit a deposit
Enrollment Payment Options
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Seat Deposit - Phlebotomy Training Program
Reserves your seat in the upcoming cohort. The $150 deposit is applied toward your tuition balance. Remaining tuition is paid in two biweekly payments of $525. Do not select this option if you plan to use the Buy Now, Pay Later option at checkout.

$150.00 Quantity



Pay in Full - Phlebotomy Training Program
Full tuition payment. Enrollment confirmed immediately upon successful payment. Select this option if using a Buy Now, Pay Later provider at checkout or paying full tuition upfront.

$1,200.00 Quantity



CPR/BLS Certification Add-On
This optional certification is highly recommended for individuals entering the healthcare field. Students who select this add-on will receive American Heart Association CPR/BLS training during the program and will graduate with an additional certification that many healthcare employers require.

$75.00 Quantity



Total

$0.00
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LOTUS HEALTHCARE ACADEMY

SECTION 1: PERSONAL INFORMATION

Important

CPR/BLS Certification (Optional Add-On)

SECTION 2: EDUCATION BACKGROUND

Enrollment Policy:

Using a Buy Now, Pay Later option? Please Read.

Enrollment Payment Options*

Enrollment Payment Options