Texas Health School Application

Name*
First Name* Last Name*
Email Address*
Address*
Street Address City State ZIP Code
Home Phone
Work Phone
Cell Phone*
Do you have a High School diploma or GED?*
- Yes
- No
Program of Choice
- Medical Assitant
- Massage Therapy
- Nurse Aide
- Medication Aide
- Vocational Nursing Program
When would you like to start?
Would you prefer day, evening or Saturday classes ?
Additional Comments
Name
This field is for validation purposes and should be left unchanged.

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