Innovative Health Care Institute Enrollment Request Form

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By completing this form, you are requesting

Email *

First Name and Last Name *

Address: Includes Street Address, city, state, zip code *

Contact Number *

Date of Birth

YYYY

Program of Interest *

Nurse Aide Training Program

Phlebotomy Technology

Clinical Medical Assistant

EKG Technology

Patient Care Technician

Med Tech (must be have an active Georgia CNA)

Undecided

Classes are offered Day, Evening and Weekends, which do you prefer? *

Days

Evenings

Weekends

Does not matter

Have you completed the following enrollment requirements? (Check all that apply)

Have a clean background check submitted to IHCI

Drug screen with negative results

Vaccinated against Covid-19

Tuberculosis Skin Test (Negative for TB)

How did you find out about our program? *

Submit

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