Please fill the survey out in order to receive a username and password. The username and password will be used to log into your Collins e-mail account and to access your online course work on Moodle.
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First Name (Please list First name on record at Collins Career Technical Center)
Last Name (Please list last name on record at Collins Career Technical Center)
Are you a former Collins Adult Student within the last 2 years?
What program are you currently in?
Advanced Medical Coding and Billing
Diagnostic Medical Sonography - Cardiac
Diagnostic Medical Sonography - General
Emergency Medical Technician
LPN-RN Diploma Program 201
LPN-RN Diploma Program 202
Medical Coding and Billing
Practical Nursing 101
Practical Nursing 102
Practical Nursing 103
Practical Nursing 104
Practical Nursing 105
Patient Care Technician
State Tested Nursing Assistant
Trade & Industry
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This form was created inside of Collins Career Technical Center.