Admissions Application

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Admissions Application

Application

To apply, please take the time to fill out the information below.

Date

Last Name

First Name

Address

Numbers of Dependents

Birthday

Home Phone

Cell Phone

Gender

Have you ever been convicted of a felony?

Marital Status

Driver's License (optional)

How long have you considered a career in this field?

Do you have reliable transportation?

EDUCATION PORTION

High School

Year

Name of School / City & State

College

Why have you selected to pursue this program?

How did you hear about us?

FUTURE CAREER AND EDUCATION PLAN

Have you discussed this with your significant other/support system?

Does your family / spouse / significant other support your educational plans?

What are your ultimate educational goals?

Have you done any research on the career you are interested in

On a scale of 1-10, how would you rate your ability to finish what you start?

FINANCIAL NEED ASSESSMENT

Have you saved money for your education?

Do you have any other source of income you can use toward your education?

Have you researched financial options that will help you pay for your education?

EMPLOYEMENT AND PERSONAL BACKGROUND

What is your work schedule?

Are you willing to reduce your work hours while you are in school?

Do you have childcare arrangements if you decide to attend school?

Why do you feel that you would be a good fit for our program?

Are you ready to commit yourself to school as the priority?

Do you manage your time responsibly?

APPLICATION FEE

Cardholder name

Phone Number

Card Number

Acceptance

I am aware that the registration has a cost of $200 and I am making the payment with my personal data which will be private under SSL protocol

Moriah
Medical
College