Williams Career School of Excellence
WCSE Medication Aide Course
Registration Form
First Name
*
Last Name
*
Date of Birth
*
Social Security Number
*
Email
*
Phone Number
*
Street Address
*
City
*
State
*
Zip Code
*
Are you a U.S. Citizen
*
Select
Yes
No
Please share why you desire to become a Medication Aide
*
How did you hear about W.C.S.E.?
*
Select
W.C.S.E. FB Page
Google
Instagram
Friend Referral
Teacher Referral
Hays Caldwell Women's Shelter
Kindred Hospital
KARE
Assisted Living Facility
Cypress Healthcare in San Marcos
Legend Oaks in Kyle
Marbridge
Bella Groves
Parkview Senior Living
I own or have access to a smart phone and/or computer/laptop with internet access?
*
Select
Yes
No
Class
*
Select Class
Medication Aide
Section
*
Select Section
June 3, 2024
September 16, 2024
Have you been enrolled in a previous training program
*
Select
Yes
No
Have you been terminated from a program
*
Select
Yes
No
If you answered yes to the previous question. Please explain the reason you were terminated or unable to complete the program.
*
Have you ever been convicted of a felony?
*
Select
Yes
No
If you have been convicted of a felony, please explain
*
High School Name
*
High School City & State
*
Did you graduate from High School?
*
Select
Yes
No
College/University Name
*
College/University City & State
*
Did you graduate with a college degree?
*
Select
Yes
No
Did you receive testing accommodations or support at a previous school?
*
Select
Yes
No
Do you have any known learning disabilities? If yes, please list them. If no, type N/A.
*
Emergency Contact
*
Emergency Contact Email
*
Emergency Contact Phone
*
What is your preferred tuition payment type? Note: Any adjustments to your selected plan will incur a $30 fee
*
Payment in full 2 weeks before class start date
50% 2 weeks before class start date + 50% 2 weeks before last day of class
You may be eligible for financial aid if you are experiencing one or more of the following:
*
You are low income
You are receiving SSI
You are receiving disability
You are currently homeless
You are in foster care or recently aged out of foster care
You are a woman over 21 and have had at least 24 consecutive months as a non-student
None of the above apply to me
Confirmation & Signature (Typing your full name below certifies your consent and agreement)
*
I certify that my answers on this document are true and complete to the best of my knowledge. If I am accepted into the Institute, I understand that any false or misleading information contained in my application or interview, regardless of the time of discovery, may result in my dismissal from the program. I understand that all information on this application is subject to verification and I consent to criminal history background checks. I also consent to references and former employers and educational institutions listed being contacted.
Fees
Mandatory Fees
Application Fee (non-refundable)
50
Total
50.00
Submit
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