Enrollment Form

This is an online registration for Northeast Medical Institute. 
Step 1) Please complete this online registration
Step 2) Once you click on submit you will be forwarded a email with a link in it- Please complete this Enrollment Agreement, etc. ( Check your spam and Junk)
Step 3) Wait 24/48 business hours for your invoice to be sent to you. 

If you are receiving State Assistance from the following organizations (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/Bridgeport
Healthcareer Advancement Program- New Haven
Workforce Alliance WIOA- New Haven
Youthworks- Bridgeport
WIOA- Hartford

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 required for CNA Students starting their online portion after 9/5/2021 due to CT DPH Requirements.


Emergency Contact

Program of Interest

Check on website calendar

If the class you choose is full due to our max capacity limits you will be added to the next available class at that location. Example; If July 5 Stamford CNA Daytime is full and you registered for this class you would automatically be put into the next Stamford CNA Daytime class. There are NO ENROLLMENT REFUNDS if you choose a class that is already full and have to be assigned to the next class.

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.

This is for students who are interested in doing all 3 courses; CNA, Phlebotomy and EKG. These three courses will allow you to take the Patient Care Tech Exam.

Due to COVID Restrictions/Delays you understand the following;
1) CNA Testing is OFFSITE and controlled by Prometric
2) CNA Self Paced Online class starts on the date you register for ( example you register for Jan 25 you start the online on Jan 25)
3) CNA Self Paced Lab/Clinical is not guaranteed to start immediately after the 2 weeks of online due to possible COVID restrictions and delays. Any questions about this contact us at 203-391-6766
4) You can not take the state CNA test until you finish all hours ( Online, Lab, and Clinical)
5) Phlebotomy Hybrid/ EKG Hybrid refer to the COVID-19 Policies and Updates for the class schedule layout.
6) You may take the CNA Online portion on a Phone, tablet or laptop.
7) You may take the Phlebotomy Hybrid course only on your laptop.

CNA Online Labs/Clinical classes may start between 1-3 weeks minimum after the 2 week period of the online course.

I acknowledge and understand that Northeast Medical Institute DOES NOT run CNA State Testing until further notice. Prometric CNA Testing is conducted offsite and Northeast Medical Institute has no control of timeframes of testing. Please Contact Prometric CNA Testing for more information.

COVID Vaccine Acknowledgement

Background Check & Drug Testing Acknowledgement

Applicants understand that there are 30 venipuncture's required and 10 capillary sticks. They must bring in volunteers to meet this requirement and volunteer themself. They must complete these requirements set by Northeast Medical institute in order to graduate and pass all requirements listed in the School Catalog. They can not receive a diploma or the NHA credential until they complete these requirements

Phlebotomy Students will need to provide the following 1 week prior to the start of their class or they may not be let into lab :

Negative PPD ( Taken within last 12 months)
Hep B Form ( You can decline getting the Hep B on the form)

NHA Requires that you either have a high school diploma or GED. If you do not have either of these you will need to show you are going to be getting this within a year of taking the exam with them. You are eligible to take the Phlebotomy course and graduate from our school with a certificate of completion without a GED or High school Diploma.

Only Required for State Funded Students

Pick which organization you are working with

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

Please provide the name of the funding source, email, and telephone number.

Payment Plan/Financing

If you are a sponsored student who has a scholarship from a organization please select from the following options;

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.

If a student registers for a course that is already full they will NOT RECEIVE A REFUND. You will be automatically put in the next available class at that campus. Please READ THE WEBSITE and NOTE that this is a First Come First Serve.

Other Fees
CNA Registration Fee Only- Self Paced Online 350
Phlebotomy Registration Fee Only 256.75
PCT Registration Fee Only 828.53
EKG Registration Only 200
Total 0.00

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