Section 1: NIHT Student Profile Form

Section 1: NIHT Student Profile Form

Please complete this form before beginning your coursework. This information will be used for student records, certificate preparation, and program communications.
- Full Name
  
  First NameLast Name
- Preferred Name (optional)
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Date of Birth
  
  MonthDayYear
  Date
- Email
  example@example.com
- Phone Number
  
  Area CodePhone Number
- Time Zone
- Certificate Information
  
  Please enter your name exactly as you want it to appear on your official NIHT Certificate of Completion.
- Certificate First Name
- Certificate Middle Name
- Certificate Last Name
- Self-Study Program
- How did you hear about NIHT?
- What is your primary goal after completing this program?
- Professional Background
- Current Employer
- Current Position
- Do you currently work in healthcare?
- If yes, briefly describe your role.
- Program Acknowledgements
- Student Acknowledgement and Agreement
  By signing below, I acknowledge and agree to the following:
  
  • My enrollment includes access to the NIHT Self-Study Program online modules and final examination.
  
  • This program does not include clinical training, clinical hours, externships, or hands-on instruction.
  
  • This program does not include live instructor-led classes.
  
  • This program does not include the Foundations of Modern Sleep Technology: An Instructional Textbook for Sleep Technologists textbook.
  
  • This program does not include a Sleep Tech Starter Kit.
  
  • Completion of this program does not guarantee employment, certification, registration, licensure, or eligibility for any credential.
  
  • State, employer, and credentialing requirements vary and may change over time.
  
  • I must email my platform-generated completion certificate to admissions@myniht.com before NIHT can prepare my official Certificate of Completion.
  
  • I have reviewed and agree to the NIHT Self-Study Program Refund Policy.
- Signature
Should be Empty:

Section 1: NIHT Student Profile Form

Certificate Information

Self-Study Program

Professional Background

Program Acknowledgements