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
$
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
$
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
$
150.00
Background Check - BCII fingerprints
$55.00
$
55.00
Scrubs
$45.00
$
45.00
T-Shirt
S
M
L
XL
XS
Reserve your Spot
$55.00
$
55.00
Make-Up Classroom Hours
$50.00
$
50.00
Quantity
1
2
3
4
5
Subtotal
$0.00
$
0.00
Tax
$0.00
$
0.00
Total
$0.00
$
0.00
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
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
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