Student Name
*
First Name
Middle Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Student Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Ally College Payments
*
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STNA Class Packages
$
595.00
Please select from 1. Basic, 2. Gold or 3. Platinum Packages: ---1. Basic - Tuition, lab supplies, e-textbook reference only --- 2. Gold - Incl Basic pkg + Background Check & Scrubs! --- 3. Platinum - Incl Gold pkg + STNA test
Package
Basic - Tuition, lab supplies, e-textbook reference only
Gold -Incl Basic pkg + Background Check & Scrubs!
Platinum - Incl Gold pkg + STNA test
Installment Payment Plan
$
300.00
2nd payment must be made by Thursday prior to classes beginning.
Package
1st payment - Basic Package
2nd payment - Basic Package
3rd payment - Bronx
4th payment - Platinum
State Testing & Scheduling Fee
$
150.00
Background Check - BCII fingerprints
$
55.00
Scrubs
$
45.00
T-Shirt
S
M
L
XL
XS
Reserve your Spot
$
55.00
Make-Up Classroom Hours
$
10.00
Quantity
1
2
3
4
5
Subtotal
$
0.00
Tax
$
0.00
Total
$
0.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Class Start Date
12/13/2021
1/10/2022
1/24/2022
2/7/2022
2/21/2022
3/7/2022
3/21/2022
4/4/2022
4/18/2022
5/2/2022
5/16/2022
6/6/2022
STNA Class start dates
STNA Test Date
TBD
STNA Test dates
CPR Date
TBD
STNA Class start dates
Detected Location
Submit
Should be Empty: