ONLINE APPLICATION FOR STUDENTS As it appears on your License or ID

Name *

First

Middle

Last

Social Security Number *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Date of Birth *

Emergency Contact Name *

First

Last

Emergency Phone Number *

Which classes are you enrolling? *

Which date(s) are you interested in? *

Click here to see calendar

How did you hear about us? *

Title *

Facility

Contact Person

Contact Number

I affirm that the information I have provided on this application, including responses to any other information that I have submitted or will submit to Premier Choice Health Services in connection with the admission, is complete and accurate and is my own work. I understand that submission of incomplete or inaccurate information is sufficient cause for revocation of admission or enrollment. *

I agree to the statement above
I have read the student policy agreement

Click here for the student policy agreement

Electronic Initials *

Date *

We make it simple to succeed!

Enrollment is easy. Classes are flexible.

Enrollment is limited and spaces fill fast so ENROLL NOW to save a seat!

Class schedules are subject to change. However, you can choose your class times.

Our program is the most affordable in Columbus at $599 with books and materials included.

Downloads
To download and view a printable version of the application and student policy

Application For Students

CNA Student Policy Agreement

HHA Student Policy Agreement

Health Certificate Form