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Allied Health - Piedmont CC
Select Class*  
Nurse Aide I, $189
Nurse Aide II, $189
Refresher, $125
Central Sterile Proc., $317.08*
Med Tech, $70
Med Aide, $70 (NC CNA certification required)
Cardio Tech/EKG, $198
Phlebotomy, $198
Pharmacy Tech, $180*
Medical Coding & Billing, Part I, $180
Medical Coding & Billing, Part II, $180
Medical Administrative Assistant/EHR, $180
Work Based Learning (WBL), $189 (enter class below)

Work Based Learning Class Title (complete only if registering for WBL):  
Cost is for class registration fee only. The cost of textbooks, state board exams, and supplies are not included.
*Textbook fees are included in the registration fee.
Class Start Date*  
Class End Date*  
Section Number*  
Class Location*  
E-Mail
Important: Enter a valid e-mail address. All correspondence will be sent to this address.
E-Mail:*  
Registrant Information
First Name:*  
Middle Initial:  
Last Name:*  
Address Line 1:*  
Address Line 2:  
City:*  
State:*  
County (NC residents only)  
Zip Code:*  
Home Phone:*  
Cell Phone:*  
Sex*  
Male Female 

Date of Birth*  
  
  
SSN*  
Colleges and Universities are asked by many, including the federal government, accrediting associations, college guides, newspapers, and your own college/university communities, to describe the racial ethnic backgrounds of our students and employees. In order to respond to these requests, we ask you to answer the following two questions:
Do you consider yourself to be Hispanic/Latino?*  
Yes No 

Ethnic Origin:*  
Educational Experience
Highest Educational Level Completed*  
Do you have a valid NC CNA Certification? This is required for those applying for Med Aide or NA II.*  
Yes No 

Employment Status
Employment Status:*  
Electronic Signature & Payment Information
I understand that having any unpaid balances wtih Piedmont Community College may affect my enrollment in this class.
*Payment must be received by the deadline. You will receive a detailed email from Lori Watlington with payment instructions and the given deadline. Please do not submit your registration until you are prepared to make payment. Students who have not submitted payment by the deadline, will be dropped and have to re-register for the course.
Signature:*  
Enter first & last name
Date*  
Amount Due:*  
Enter registration amount
Photography & Quote Release: I hereby authorize Piedmont Community College to use my image and/or quotes for any use the College deems appropriate in the promotion and marketing of PCC. I fully discharge PCC from any and all claims, monetary or otherwise, arising out of the image or quote.
Signature:  
Optional, sign if authorized
Date:  
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