Registration Form
Please reserve a place for me in the following session:
Community Health Worker Certificate: Thursday, April 18 , 4 p.m.
Community Health Worker Certificate: Thursday, May 16, 4 p.m.
Health Information Specialist/Medical Coding: Monday, April 8, 4 p.m.
Health Information Specialist/Medical Coding: Monday, May 6, 4 p.m.
Nursing, Associate Degree: Wednesday, April 10, 4 p.m.
Nursing, Associate Degree: Thursday, April 25, 4 p.m.
Nursing, Associate Degree: Wednesday, May 8, 4 p.m.
Nursing, Associate Degree: Thursday, May 23, 4 p.m.
Occupational Therapy Assistant: Tuesday, April 9, 4 p.m.
Occupational Therapy Assistant: Tuesday, May 14, 4 p.m.
Phlebotomy, Certificate: Thursday, April 11, 4 p.m.
Phlebotomy, Certificate: Monday, May 13, 4-5 p.m.
Physical Therapist Assistant: Tuesday, April 16, 4 p.m.
Physical Therapist Assistant: Tuesday, May 21, 4 p.m.
Radiography: Friday, Aprl 12, 1 p.m.
Radiography: Friday, May 10, 1 p.m.
Sonography: Wednesday, April 10, Noon
Sonography: Wednesday, May 8, Noon
First Name
(required)
Middle Name
Last Name
(required)
Maiden Name
(if applicable)
Nickname
(if applicable)
Address
City, State, Zip
,
Home Phone
Work Phone
Cell Phone
Email
(required)
Date of Birth
(required - MM/DD/YYYY)
Have you requested literature or applied to St. Catherine University before?
(required)
Yes
No
Please send me an information packet:
Yes
No