* = Required Information
A: STUDENT INFORMATION

First Name

Middle Name

Last Name
Female Male
Yes No

B: COURSE INFORMATION
CPR & First Aid $45 Direct Care Worker $300
NCLEX Review $750 Nursing Assistant $500
Pharmacy Technician $999

C: METHOD OF PAYMENT
Cash Check Money Order
(For Checks and Money Orders, please make payment payable to Barnabas Health Care School of Propessional Studies)

Payment of enrollment fee constitutes certification that the information on this enrollment form is corect, that the refund policy (all tuition and fee paid by the applicant shall be refunded if the applicant is rejected by the school or if applicant requested for refund within three business days after signing a contract with the school. No refund will be made after the end of the 3rd class day. The only exception to this policy will be for military service, death in immediate family, serious illness or hospitalization. A written request for exception to the refund policy must be submitted to the Administrator's office within 5 days of last class attendance. All refunds shall be refunded within 30 days) is understood, and that the rules and regulations in the Barnabas Health Care School of Professional Studies catalog have been read and will be abided by:

(If Student is less than 18 years)
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