Phlebotomy Funding Interest Form

Phlebotomy Funding Interest Form

Ready to take the next step toward becoming a Phlebotomy Technician? Through our partnership with Dwyer Workforce Development, eligible students may qualify for training support.Complete this short form and Lotus Healthcare Academy will contact you first to discuss the program, answer your questions, and explain the Dwyer referral process.Please note: Completing this form does not guarantee enrollment or funding. Eligibility for Dwyer Workforce Development services is determined by Dwyer.
SECTION 1 - Tell Us About You
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
SECTION 2 - Cohort Selection
Which cohort are you interested in?
Which class are you interested in?
Are you at least 18 years old?
Do you have your high school diploma/GED?
Is there anything you’d like us to know or any questions you have about the program?
Should be Empty:

SECTION 1 - Tell Us About You