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Course Application Form
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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 $549.00 Medical Biller $449.00 Certified Nurse's Aid $999.00 PharmacyTechnician $999.00
EKG Technician $499.00  Patient Care Technician $949.00 Medical Assistant $4500.00 Dialysis Tech $1195.00
Choose Phlebotomy Technician and EKG Technician together and save $100!
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 28th & 29th Street
Call and talk to a live rep: 212-564-1234