Medication Aide Administration Hybrid Course (Adult Care Home Setting) Payment

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Medication Aide Administration Hybrid Course (Adult Care Home Setting)

Price: $361 (includes Stripe charges)

(covers tuition and books)

PESONAL INFORMATION

First Name *

Last Name *

Street Address *

City

State/Province *

ZIP / Postal code

DOB *

Month *

Day *

Year *

Cell Phone Number *

Home Phone Number

Alternate Contact

Emergency Contact

Email Address *

Are you over 18 years old? *YesNo

Have you been convicted by any government agency of child, patient, resident or elderly abuse? *YesNo

Are you being sponsored by a certifying facility? *YesNo

If yes, you're only responsible for any cost that are not covered by the facility.

EDUCATION

School *

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Month

Day

Year

End Date Mo/Yr

Did you graduate? *YesNo

Degree *

COLLEGE/UNIVERSITY

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Did you graduate?YesNo

Degree

OTHER EDUCATION

OTHER CERTIFICATION

EMPLOYMENT HISTORY

(most recent employment first)

Employer Name *

Employer Address *

Start Mo/Yr *

Month

Day

Year

End Date Mo/Yr *

Month

Day

Year

Position *

Employer Name

Employer Address

Start Mo/Yr

End Date Mo/Yr

Position

Employer Name

Employer Address

Start Mo/Yr

End Date Mo/Yr

Position

CPR Certified?YesNo

How did you hear about us? *

I certify that the information provided in this application is true and complete to the best of my knowledge. I agree that if I misrepresent or omit any relevant information or provide false answers, AllGrace College of Health Sciences will disqualify or discharge me from the program without refund.

Date Submitted *

I understand that my spot is only secured after completing payment

Credit / Debit Card *

Contact us

Phone: 1-980-616-2758

Email: allgracecollegeofhealthscience@gmail.com

Locations:

19109 West Catawba Ave, Suite 200, Cornelius, North Carolina, 28031

1700 Spears DR NW, Concord, NC 28027

7714 Matthews Mint Hill Road, Unit E, Mint Hill, NC 28227

5308 River Falls Drive, Charlotte, NC, 28215

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