Online Program Application & Scholarship Request

Online Program Application & Scholarship Request

Scholarship DisclaimerThe $500 scholarship is a tuition award and does not cover the full cost of the selected program. Scholarship recipients are responsible for paying the remaining tuition balance and any applicable fees according to Phlebotome Medical Training Institute’s established payment requirements.If selected, recipients will have 7 calendar days from the date of their scholarship award notification to accept the award, complete enrollment, and apply the $500 scholarship toward an eligible online program.If enrollment is not completed within the 7-day period, the scholarship will be forfeited and may be offered to another applicant.Submitting a scholarship application does not guarantee approval or enrollment. Only five (5) applicants will be selected to receive the $500 scholarship.Scholarship awards have no cash value, are non-transferable, cannot be exchanged for cash or refunded, and may only be applied toward an eligible online program at Phlebotome Medical Training Institute.By submitting this application, you acknowledge that you have read and understand these terms and agree that, if selected, you will be financially responsible for the remaining program balance after the $500 scholarship has been applied..
Applicant Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Highest Level of Education Completed
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Would you like to apply for the $500 scholarship?
Program Selection
Please explain why you are applying for the scholarship
Should be Empty: