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Allied Health - Piedmont CC
Select Class*  
Nurse Aide I, $188.90
Nurse Aide II, $188.90
Nurse Aide Refresher, $125
Medication Tech, $70
Medication Aide, $70
Cardiovascular Tech, $197.90
Phlebotomy, $197.90

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:*  
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
*Payment must be received within 48 hours, do not submit until you are ready to pay. Payment instructions will be sent via email. Students who have not submitted payment within 48 hours, will have to re-register for the course.
Amount to be Charged*  
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