Manhattan Institute Medical and Nurse Career School New York NY

Course Application Form

Application for Admission		Data on this form is security encrypted and sent to admissions, maintaining your privacy and security at all times
Name*	A value is required.	Address*	A value is required.
City*	A value is required.	State*	A value is required.
Zip Code*	A value is required.Invalid format.	Home Telephone*	A value is required.
Cell Phone		Birth Date(mm/dd/yyyy)*	A value is required.Invalid format.
Email*	A value is required.Invalid format.	How did you learn about Manhattan Institute?
Educational Background
High School Attended		Address
Did you graduate?	Yes No	If yes, date graduated(mm/dd/yyyy)?
Do you have a G.E.D.?	Yes No	Date Received(mm/dd/yyyy)
State		Have you ever attended any other school?	Yes No
Name and location of school
Current Employment Information
Are you working Now?	Yes No
Name of company		Years there
Address		Your position
Work Telephone
Classes and Pricing (financing is available)*
Phlebotomy Technician $649.00	Medical Biller $499.00	Certified Nurse's Aid $1299.00	Pharmacy Technician $1199.00
EKG Technician $649.00	Patient Care Technician $1099.00	Medical Assistant $5000.00	Dialysis Tech $1499.00
Choose Phlebotomy Technician and EKG Technician together and save $200! Phlebotomy and EKG Combo: $1099
Section*
I wish to attend classes:	During the day During the evening On the weekend

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Feel free to call us 7 days a week for information and speak to a live representative

The Manhattan Institute
255 Fifth Avenue, New York, NY 10016
6th floor - Between 28 & 29 Street
Call and talk to a live rep: 212-564-1234

Licensed Institution