Addmissions Application Form

Admissions Application

Please complete the form below to apply for a position with us.
Full Name

First NameMiddle NameLast Name
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email Address
Phone Number

Area CodePhone Number
Applying for what class
Start date

MonthDayYear
Upload Resume

Upload a File

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Upload Drivers License/ID

Upload a File

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Upload Ged/High School Diploma or Transcript/College Transcript

Upload a File

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Highest Level of Education
Graduation date

MonthDayYear
Date
Ged/High School Name
College Name
Certificate/Diploma/Degree
I attest that I will provide a copy of my degree/transcript prior to graduation
Signature
Employer Name
Employer Status
Start Date

MonthDayYear
Date
End Date (if not employed)

MonthDayYear
Date

Why should you be chosen to be a Student at the Buckhead School Of Medicine?
Can you commit to 32-40 hours a week for school and clinicals?
Can you arrive to class and clinicals on time?
Can you keep patient records confidential according to the HIPAA policy?
Do you have access to wifi or ethernet internet for online/distance education classes?
Are you disciplined to participate online/distance education classes?
Do you have a smartphone ?
Do you consent to SMS (text) messages from Buckhead School of Medicine ?
Do you have a laptop or PC computer with camera and audio speakers?
Do you give Buckhead School of Medicine Permission to post your social media feedback/post that you post on the schools website/google/yelp/social media platform ?
Do you give Buckhead School to share post on all social media outlets ?
Why do you want to be in the healthcare industry?
Social Security Number
Birth Date

MonthDayYear
Date

USD1

Credit Card

Apple Pay

Google Pay

Cash App Pay

Admissions Application