Register

Premise Career Academy Registration Form

First name

Last name

Email

Phone

Birthday

Month

Day

Year

Multi-line address

Country/Region

Address

City

Zip / Postal code

Course Choice

Medical Assistant

Medical Assistant Refresher

Payment Method

WIOA Recipient

Scholarship Applicant

Self Pay - Includes Buy Now Pay Later

If you are working with Texas Workforce Solutions, please provide your case manager's name.

Case Manager's Contact Number

Case Manager's Email

I have a high school Diploma or GED

Upload High School Diploma or GED

You are required to have a laptop or a tablet for online learning.

I have my own laptop or tablet

I need a loaner - $300 refundable deposit required for loaner

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

The medical assistant course is 420 hours total including a 2 month externship. You will be notified of your start date once we receive your registration form.

For Self Pay Students

Medical Assistant Certification Course - Full Payment$12,000

Medical Assistant Certification Course - Down Payment$2,000

Medical Assistant Certification Refresher Course$600

Laptop Needed

Laptop Loaner Fee$300