* Required Information
Course Registration Application Form
Date of Application
*
How did you find out about Sevenwonders?
*
Please select
Agent
Walk-in
Friend
School
Social Media
Other
Student Biography
First Name
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Last Name
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Select Age Group
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Please select
18-24
25-35
36-45
46-55
>56
Gender
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Male
Female
Phone Number
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Cellphone
*
Email
*
Home Address
*
Emergency Contact Name
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Phone Number
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Course Options
Select Course to Attend
CNA Program (Tuition $967.50)
CMA 1 Program (Tuition with Taxes $1,348.13)
Additional Costs
Background Check ($75.00)
TB Test ($40.00)
Class Options
Day Class
Evening Class
Weekend Class
Location of Class
Central Region
North Region
South Region
School Information
Highest Level of Education
Are you enrolled in another school program?
Yes
No
Which Program?
Method of Payment
State funding
County
Are you an active TANF Participant?
Yes
No
Private Pay
Select Payment Plan Option
Full payment
Two payment plan
Three payment plan
I acknowledge and attested that the information given in this application is accurate to the best of my knowledge.
Student/Parent Signature
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Date
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