Register Phoenix Healthcare Institute Registration Form Please use the form below to register for our program NEW STNARETURNING STUDENT First Name : Middle Name : Last Name : Address : Apt # : City : State : Zip Code : Home Telephone Number : Cell Number : Date of Birth : Email : Emergency Contact : High School : Did you graduate ? YesNo College : Did you graduate ? YesNo Others: Did you graduate ? YesNo Jobs & Employer Employer : Position : Reason for Leaving : 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 Phoenix Healthcare Institute 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. We reserve the right to reschedule or cancel any course that does not meet our minimum enrollment requirements. If a course is cancelled or rescheduled, all fees paid are subject to reimbursement or transference upon presentation of a receipt Phoenix Healthcare Institute Providing the best STNA classes, NCLEX Review, Train the Trainer, First Aid Training, and CPR courses: 25000 Euclid Ave Suite 300 Providing STNA classes, NCLEX Review, Train the Trainer, First Aid Training, and CPR courses: Euclid, OH 44117 (216) 486-2900 phxhealthcare@gmail.com
