SOAH Admissions Application

Allied Health Admissions Application

701 Wiltsey's Mill Road Suite 103 Hammonton NJ 08037
Student Information

Please spell your name the way you would like it spelled on all official documentation.
Student's Full Name*

First NameMiddle NameLast Name
Current Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth (MM/DD/YYYY)*
Age*
Last 4 digits of SS# *
This information is secure and will be used for test registration purposes only. Will not appear on printed versions of this form
Gender*
Phone Number*
Marital Status *
Email*
example@example.com
Citizenship *
Military Service*
If Yes, Dates of Service
example@example.com
Emergency Contact

The person listed will be contacted in times of a medical emergency or if the school looses contact with the student.
Full Name. *

First NameLast Name
Phone Number*
Relationship to student *
Previous Education

proof of High School Graduation (Diploma or G.E.D) is a requirement for entry.
What is your highest level of education?*

High School/GEDSome CollegeUndergraduate & beyond
Can you provide proof of graduation*

YesNo
Name of High School *
Year of graduation*
Name of College/University
Year of graduation
Have you previously attended a career training program ?*

Yes, and I completed the programYes, and I did not complete the programNever attended
If you answered yes to the above question, please provide detail about the program?
Are there any learning challenges we should be aware of? If None, type N/A*
Do you have access to a computer and the internet?*

YesNo
Programs require the use of online learning management systems. Do you have any concerns about the use of computers to access your course outline?*

YesNo
Personal Background

Enter your personal background information below
Do you have any criminal charges pending or resolved?*

YesNo
Have you ever been informed that you are ineligible to work with children or the elderly?*

YesNo
Do you have any criminal history that would make you ineligible to work with children or the elderly?*

YesNo
Do you have adequate transportation to weekly clinicals?*

YesNo
I have answered the above questions honestly to best of my knowledge*

YesNo
Program Registration

Please make sure you are selecting the correct program and entry date prior to submission. Entry dates are subject to change. All dates will be confirmed by Admissions. Information on all programs can be found the school's website at www.soah.education
Medical Assistant Program
Phlebotomy Program Program
Patient Care Technician Program
Medical Office Assistant Program
Additional Required Materials Checklist

The following documents will be requested to move forward with enrollment: High School Diploma/Transcript/GED and Valid Photo ID.
Payment & Application Fee

Please select the the desired tuition arrangements. Please view and select the desired payment plan if applicable. All payments plans are for the remaining balance post deposit payment.
Tuition arrangements:*

I would like to pay in full.I would like to establish a payment plan
Medical Assistant Program Payment Options. Tuition $1600.00 Deposit $350.00
Phlebotomy Program Payment Options. Tuition $1200.00 Deposit $348.00
Patient Care Tech Program Payment Options. Tuition $1400.00 Deposit $316.00
Medical Office Assistant Payment Plans. Tuition $1000.00 Deposit $250.00

All admission applications require a $25.00 non-refundable application fee

Application Fee

$25.00

Total

$0.00

Payment Methods

Credit Card

Apple Pay

Cash App Pay

Should be Empty:

Allied Health Admissions Application

Student Information

Emergency Contact

Previous Education

Personal Background

Program Registration

Additional Required Materials Checklist

Payment & Application Fee

Payment Methods