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.
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.