Enrollment Form

This is an Enrollment Form for Northeast Medical Institute. Please read through the School Catalog and Enrollment Agreement at the end of this registration process before finishing this enrollment form.

If you are receiving State Assistance from the following orginzations (below) and are not approved yet please do not fill out this form please fill out a Financial Assistance form on our website.

WIOA( American Job Center)- Stamford
HealthCareer Academy- Bridgeport
Healthcareer Advancement Program New Haven
Workforce Alliance WIOA- New Haven
Youthworks- Bridgeport

If you are approved by one of these organizations at the end of the form please do not click on any payment options. Just leave it blank.













Personal Details

Example: 10-30-1980

This is the date you fill out this paperwork

THIS IS NOT REQUIRED TO REGISTER BUT WILL BE REQUIRED TO COME INTO CLASS FOR LAB/CLINICAL.

Address

Emergency Contact

Program of Interest

Check on website calendar

Only Check if you are in the CNA or PCT Program. These can not be exchanged or returned.

Only Check if you are in the Phlebotomy or PCT Program. These can not be exchanged or returned.

This is only for students who have completed a CNA course in the past 2 years and have proof to show Northeast Medical. If you do not show proof upon registration you may not be accepted.

Only Required for State Funded Students

Pick which organization you are working with

Please provide your career advisors name, email, and telephone number.

Payment Plan/Financing

Would you like to be contacted about our payment plan? We require all students to be fully paid by the second Monday of class. YOU MUST PAY FOR THE REGISTRATION FEE IN ORDER FOR YOUR REGISTRATION TO BE VALID. PLEASE READ THE SCHOOL CATALOG TO GO OVER OUR PAYMENT PLAN WHICH WE WILL AUTOMATICALLY ADD TO YOUR ACCOUNT IF YOU CLICK YES BELOW.

This is based on your personal Credit Score

Online Self Paced CNA
Tuition $1,200
Supplies (Stethoscope & BP Cuff & Gait Belt) $50
Scrubs 1st set free
Registration Fee: $350
Program Total: $1,600

Does Not Include (Will be added to the invoice):
State Exam Prometric- $118 ( Not Paid to the School)
HPSO Insurance -$25
2nd Set of Scrubs - $25.0
Background Check – $12.95


Phlebotomy
Tuition $1,160
Lab Tech Coat included free
Supplies $90
Books $60
Registration Fee $250
Program Total: $1,560

Does Not Include(Will be added to the invoice):
NHA Exam - $115 ( Paid to NHA)
HPSO Insurance -$25

EKG
Tuition $250
Supplies $50
Registration Fee $200 (non-refundable)
Program Total: $500

Does not include:
NHA PCT Exam- $155 (Paid to NHA)

PATIENT CARE TECH (PCT) PRICING IS JUST ALL 3 COURSE PRICES COMBINED

Registration Payment Required for those who are not State Funded

A student may cancel his/her Enrollment Agreement 20 days before the first day of the program without any tuition and fee charges, except for the Non-Refundable Registration Fee. No refunds will be provided if less than 20 days remain prior to the start of the class. A student may also cancel the Enrollment Agreement without penalty or obligation by the period deadline ( 20 days before the class start date). The student will receive a full tuition refund 20 days prior the start of a course (except for the non-refundable Registration Fee). Refundable tuition is defined as the total course tuition excluding the Non-Refundable Registration Fee.


Optional Fees
CNA Registration Fee Only- Self Paced Online 350.00
CNA Registration Fee Only- In Person 256.75
Phlebotomy Registration Fee Only 256.75
PCT Registration Fee Only 715.50
EKG Registration Only 200.00
Total 0.00
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