Online PCT Enrollment & Installment Payment Form

Online Restorative Care Aide Enrollment & Full Payment Form

To pay the entire amount for Restorative Care Aide program at once, please enter the required information in this form. The Certification Exam fee of $150 is separate and is payable to American Education Certification. It is to be paid towards the completion of the program. Our task is help you succeed.
Please select the payment(s) you are making today*
prevnext( X )
Online Restorative Care Aide Full Payment$1,327.67

Total $0.00
Your Name*

PrefixFirst NameMiddle NameLast Name
Your E-mail*

Confirmation Email
Cell Phone*

Area CodePhone Number
Phone Number 2

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Should be Empty:

Online Restorative Care Aide Enrollment & Full Payment Form