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Admissions Application
Thank you for deciding to complete your application. Once you have answered the questions below, a representative will contact you within 24 hours with your approval status and further instructions.
Basic Information
First Name:
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Last Name
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Street Address
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City
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State
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Zip Code
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Day Phone Number
*
Evening Phone Number
E-Mail Address
*
Background Questions
What is your status?
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Active Duty
Military Spouse
Veteran
None
What is your spouse's pay grade:
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E-1
E-2
E-3
E-4
E-5
W-1
O-1
O-2
N/A
Other
Name of Military Branch
*
Air Force
Army
Coast Guard
Marine Corps
Navy
Program of Choice
I am interested in the following program (s):
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Pharmacy Technician
Medical Billing
Medical Coding
Administrative Medical Assistant
Administrative Medical Assistant & Pharmacy Tech
Administrative Medical Assistant & Medical Billing
Administrative Medical Assistant & Medical Coding
Certified Clinical Medical Assistant
Certified Physical Therapy Aide
Fitness Nutrition Specialist
Healthcare IT Technician
Medical Billing & Coding
Medical Technical Support Specialist
NASM Certified Personal Trainer + AFAA Group Fitness Instructor
Pharmacy Tech & Medical Billing
Pharmacy Tech & Medical Coding
Personal Training
Other Information
Once you are approved, when will you be able to start your program?
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Immediately
Within 1-2 weeks
Within 3-4 weeks
Not sure
How did you hear about us?
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Counselor/teacher
Craigslist
Family/friend
Internet
MYCAA Program
Poster
DETC
Email Ad
Magazine Ad
Other
Postcard
School Representative
Please state specifically how you heard about us.
*
Comments/Questions
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