General Enrollment Application

You must pay a $150 Non-Refundable Application Fee with submission of this application or it will NOT be processed. If you are being referred by a 3rd party agency, you may bypass the application fee at this time.

Today's Date *

First Name

Last Name

Race

Gender:

Program of Study *

Cohort Date *

Social Security Number *

Date of Birth *

Upload a Copy of Social Security Card *

Upload Government-Issued Photo ID here (DL/State ID/Passport) *

Address

Street Address

City

State

Country

Postal code

Were you referred by a former HCTI student? if so, please list their name.

Phone *

Email *

Have you ever been convicted of a Felony? *

Have you ever been placed on an Abuse Registry? *

Referring Party/Agency

Cohort Start Date: Select the Course in Which You are Enrolling? ALL Classes require $150 Application Fee or 3rd Party Agency Referral- If you select a Payment Plan, an additional $50 Payment Plan fee will be DUE TODAY *

Please indicate your t-shirt size here:

Upload a copy of a current 2-STEP TB skin test (within) 12 months of this's date. If you do not have one, you may complete the enrollment but need to begin the process of obtaining one. Contact the office for a referral list.

Reading Assessment: If you do not submit a High School Diploma, you must successfully complete the reading assessment here and forward the results to [email protected]: English Grade 7 - Reading Comprehension Test 11

Upload Copy of High School Diploma - If you do not have one, you will be required to take a Math/Reading assessment prior to acceptance into the Program

Signature of Acknowledgment/Statement of Understanding: By Signing here, I acknowledge that I have read and understand the Statement of Understanding (link here: https://api.leadconnectorhq.com/widget/form/tRDJ51TZqut678L93hkY?notrack=true *

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Signature of Acknowledgement/Refund Policy: **Please read CAREFULLY** By signing here, I acknowledge that I have read HCTI's Refund Policy which is available at https://hctiky.org/refund-policy. I understand that there is a NO REFUND policy. Any payment made including payments for application fees, tuition, payment plan payments, fees or any service/product is NON-REFUNDABLE! *

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***You must pay a $150 Non-Refundable Application Fee in order for this application to be processed. This amount goes toward the total course cost* You may also pay the ENTIRE course amount up front by selecting "Other Amount" below. If you chose a Payment Plan, you must add $50=Total Due Today $200***

$ 150

$ 200

Other amount

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Health Careers Training Institute is a Kentucky-based technical school offering accelerated healthcare training programs including CNA, Phlebotomy, Certified Medication Aide, Pharmacy Tech, Medical Assistant and EKG Technician courses. Our mission is to help students enter the healthcare workforce quickly with practical, affordable education.

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Programs

Certified Nursing Assistant (CNA) Training
Phlebotomy Technician Training
EKG Technician Training
Certified Medication Aide

Pharmacy Technician

CPR Classes

Medical Assistant

Contact Info

(502) 290-2999

[email protected]

1941 Bishop Lane, Suite 1004, Louisville KY
40218

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