Fill out the online application fields below. You must attach a personal statement about your interest in this program and the dental field.*A non-refundable $75 application fee must be submitted with the student registration.
ALL AREAS MUST BE COMPLETED
Full Name
Address:
City:
State:
Zip Code:
Age:
DOB:
Sex (Male/Female):
Best contact number:
Email:
High School:
Award type:
College:
Other:
Company:
Phone:
Date Started:
Date End:
Name:
Relationship:
---Canton: April 13 - June 8 2019Duluth: April 13 - June 8 2019Roswell: April 13 - June 8 2019
What form of payment will you choose to cover tuition: (Please note, tuition must be paid in full before start of class)
---CashCheckCredit CardDebit CardCare CreditPaypal Credit
Files must be pdf, doc, or txt format
Scrub top size XSSMLXLXXLXXXL
Scrub bottom size XSSMLXLXXLXXXL
Fit: NormalPetiteTall
Required for uniform, SCRUBS RUN BIG, CHOOSE 1 SIZE SMALLER THAN USUAL SIZE
You will be redirected to submit your $75 application fee via paypal.com