Student Enrollment AgreementQuestions? email info@carolinacareerschool.com Name * First Name Last Name Full Address * Cell Phone Number Other Phone Date of Birth MM/DD/YYYY Last 4 digits of Social Security Number Email * Highest Level of Education Name and Location of High School/Institution that Issued Diploma/GED Year Issued Present Employer Current Occupation Emergency Contact Name Relationship Contact Address Contact Phone Select the Course you will be attending: Friday Dental Assisting Dental Administration Phlebotomy Saturday Dental Assisting Patient Care Technician EKG Technician Clinical Medical Assistant Start Date Start Date MM DD YYYY How did you hear about our school? Internet Search Social Media Google Search Word of Mouth I hereby apply for enrollment in Carolina Career School, herein after referred to as “CCS,” in the Entry-Level Training program. A representative has provided me with a catalog and explained the programs and terms of the Enrollment Agreement. I have been provided with the Total Tuition of the Course. The $200.00 is non-refundable after 3 days of signing this Enrollment Agreement unless the course is canceled by the school. Carolina Career School does not guarantee employment nor guarantee transfer of credits. I am 18 years or older or have permission from my parent or guardian: * Initials and or Signature First Name Last Name Thank you!
