Harris Training Institute, Inc. - ONLINE APPLICATION
www.harristraininginstitute.com - State-Approved Nurse Aide classes
RESERVE YOUR SEAT TODAY!
Seating is assigned on a first come basis in the order the registration and payment is received.
PLEASE PROVIDE YOUR PERSONAL INFORMATION BELOW:
Name: (Last, First,)
Date of Birth ( MM / DD / YY )
Street Address
City, State and Zip Code
Best Number to Reach You:
BEST TIME TO CALL
Hours
 
 : 
Minutes
 
Email Address
Highest Education Level Completed:
SELECT A COURSE
NURSE AIDE I COURSE $575
NURSE AIDE I REFRESHER $275
MEDICATION TECHNICIAN $225 (Include Student Manual)
FORM OF PAYMENT
Provide your Case Manager's Name and contact number if appropriate