REGISTRATION FORM
Please print to fill out & mail in along with registration fee or you may
pay now by using paypal, visa, mastercard or discover card & choosing
the appropriate buy now button below then fill out form & bring it in,
mail it in or fax it to us at 740 205-0097.
This application is for admission to a program of study at  TTC. Upon
submitting this form you are acknowledging complete responsibility for
all Fees and pre-requisites .
Name___________________________________________________________

Address__________________________________________Apt.____________

City__________________________State__________Zip Code____________

Phone___________________  E-Mail_________________________________

                          Program Applying For
             (Please call office for availability of class dates, all classes are on a first come bases)


STNA - Date of class registering for __________________________________

Phlebotomy -  Date of class registering for _____________________________

Registration/ Tuition Fee Included $________  Paid on web site $__________

Education-   High school diploma________     GED_______      Neither_______

How did you hear about us:  Website_____  Friend________   Student_______

Sign (where)_____________   Job Fair_______  Job & Family Services______

Opportunity Links_______  School (name)______________________________

Other___________________________________________________________

Signature_______________________________    Date___________________

                                                         
TTC
Phlebotomy
full tuition

$700
STNA
full tuition

$750
STNA
registration fee

$150
Phlebotomy
registration fee

$100