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HSE-TEST
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CT - Self Pay
Student Name:
(Required)
First
Last
Student Phone Number
(Required)
*Please take a moment to double check the phone number you entered for accuracy, and make sure you can receive messages and calls at this phone number, as this is how we will contact you.
Student Email
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Gender
(Required)
Male
Female
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Date of Birth
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MM
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Age
Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Please select your career training option below:
(Required)
Auto Maintenance
Digital Literacy + Microsoft Office Basics
Certified Nurse Aide (CNA)
Emergency Medical Technician (EMT)
Firefighter 1 & 2
Heating, Ventilation, Air Conditioning (HVAC)
Medical Assisting
Welding
If you have a PSID#, please type that here.
*This is not required.
Social Security Number:
(Required)
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Are you working?
(Required)
Yes
No
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Employer/Company Name
(Required)
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Do you work Part-TIme or Full-Time?
(Required)
Part-Time
Full-Time
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Education Status:
(Required)
No High School Diploma
High School Diploma, HSE, or GED
Some postsecondary, no degree
Postsecondary Certification/License/Degree
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Are you currently in school?
(Required)
Yes
No
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Last school attended:
(Required)
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Previous schooling location:
(Required)
U.S.-based schools
Non-U.S.-based schools
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Have you read the course description?
(Required)
Yes
No
Please go to our Careers page and read the course description now.
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Why are you interested in this career training class?
Upload your Drivers License/Photo ID:
(Required)
Max. file size: 64 MB.
Upload your Diploma or HSE
(Required)
Max. file size: 64 MB.
Refund Policy Agreement
(Required)
I understand and agree to the refund policy.
Up to 24 hours prior to the first class session, a refund may be requested, less a $10 cancellation fee. Withdrawals made after the first class session, but at least 24 hours prior to the second class session, will be assessed a $25 cancellation fee. No refunds will be issued after the second class session. Credit card payments may be refunded to the same card immediately. All cash and check payments will be refunded as a check that is issued after approval by the Central Nine Career Center Governing Board. Please allow 6-8 weeks for check refunds to be processed.
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