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Allied Health - Piedmont CC
Select Class*  
Nurse Aide I, $188
Nurse Aide II, $188
Nurse Aide Refresher, $125
Medication Tech, $70
Medication Aide, $70
Cardiovascular Tech/Monitor, $188
Healthcare Provider CPR, $75

Above cost is only for class registration fees. The cost of textbooks, state board exams, and supplies are not included.
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:*  
Work 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*  
Employment Status
Employment Status:*  
Electronic Signature
I understand that having any unpaid balances wtih Piedmont Community College may affect my enrollment in this class.
Signature:*  
Enter first & last name
Date*  
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:  
Payment Information
*Please note, you are not guaranteed a seat until payment has been received.* You will be contacted via email with instructions on how to submit payment to the Business Office. PCC offers Student Accident Insurance for $1.25 per semester. Please add $1.25 to your registration fee if you elect to pay for this insurance.

Optional Student Insurance at $1.25/semester?*  
No, Decline Insurance Yes, Accept Insurance 

Amount to be Charged*  
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