Orlando Academy of Health

		APPLICATION
	Applicants to the School must meet with the Admissions Coordinator for an interview. Applicants who decide to apply for admission will complete an enrollment agreement for the program of study. Registration fee of $50.00 is due at the signing of the enrollment agreement.

First Name:
Middle Initial:
Last Name:
Suffix:
Address:
City:
State:
Zip Code:
Email Address:
Telephone (home):	( ) ( ) -
Telephone (mobil):	( ) ( ) -
Telephone (work):	( ) ( ) -
Birth date:
Gender	Male Female
Ethnicity
U.S. Citizen	Yes No
Do you have a valid drivers license or ID?	Yes No
If yes:	# State
Do you have access to a reliable Computer and Internet Connection? (Online programs require online student participation at a minimum of four (4) days per week)	Yes No
Is English your primary language?	Yes No
English is the language of instruction. All students whose primary language is not English, must show proficiency in English before being admitted.
Section 2: Previous Education and Experience
Last High School:
City:
State:	State
Did you graduate?	Yes No Year
GED?	Yes No
List Colleges/Training Institutes previously attended:
List all degrees, diplomas, and certificates received:
If you plan to transfer previously completed credits, official transcripts are required. Mail trascripts to the following address: 1650 Sand Lake Road Suite 115, Orlando, FL 32809
List your military experience (if applicable):
Branch:
Date of term:
Status:
(Orlando Academy of Health strives to have all graduates obtain jobs in their field of training. You may not qualify to work in certain vocations if you have been convicted of a misdemeanor or felony.) Have you ever been convicted of a:
misdemeanor?	Yes No
felony?	Yes No
Section 3: Your Interests
For which program are you applying?

Why do you want to continue your education through an online program?