HOME|CONTACT US
CAMPUS BROCHURES:
Apply Online

Complete the form below and one of our admissions representatives will contact you within the next few days.

Personal Contact Information

First Name: 
Last Name: 
Street Address: 
City: 
Zip Code: 
State: 
E-Mail: 
Phone: 
(i.e. 555-555-5555)
Date of Birth (mm-dd-yyyy): 
Sex: 
US Citizen:  YesNoU.S. Permanent Resident
Campus:   
Program: 

Education Information
Name of High School
or College
State		 Dates of Attendance
Month and Year		 Expected date
of graduation

Full- and part-time jobs held
Employer City/Telephone Type of Work
Start/End date of Employment
Hours/Week


Employer City/Telephone Type of Work
Start/End date of Employment
Hours/Week


Employer City/Telephone Type of Work
Start/End date of Employment
Hours/Week
      High School Graduation or GED Year: 
 

By providing my email address and submitting this form, I may be contacted by Sally Holland or another admissions representative.


Not all programs are offered at all campuses.
SEARCH TOOL
Click the link below to search for brochures: Search
Program Brochures:
Computerized Accounting Technology Dental Assistant Health Claims Specialist Legal Office Technology Massage Therapy Medical Assistant Multi-Skill Health Technician Pharmacy Technician Professional Medical Assistant Surgical Technology
©2010 Premier Education Group. All Rights Reserved.