Halo Health Academy Enrollment
We are excited that you have chosen to pursue your healthcare training with us. Please complete this enrollment application carefully and accurately. The information you provide will help us ensure proper placement, certification eligibility, and compliance with state and national training standards.
APPLICATION INFORMATION
Which Program you're interested in:

Medical AssistantPhlebotomyPatient Care TechEKG TechnicianCPRBLS
STUDENT INFORMATION
Full Name of Student/Applicant

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Gender

MaleFemale
Will the student leave from the program after graduation?

YesNo
Upload 2 forms of ID

Cancelof
I hereby certify that the information I have provided in this application is true and complete to the best of my knowledge. I acknowledge that I have read, understood, and agree to abide by Halo Health Academy’s school policies, guidelines, and student code of conduct.
I give my full consent to the school registrar to verify and/or provide the necessary information pertaining to my academic records, certifications, and enrollment status for official purposes. I understand that any false or misleading information may result in denial of admission or dismissal from the program.
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Halo Health Academy Enrollment