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Continuing Education Application
NOTE:
By completing this application, you
WILL NOT
be receiving college credit. If you would like to receive college credit you will need to complete our regular admissions application,
https://fs30.formsite.com/SalinaTech/SATCApplication/index.html
First Name
*
Middle Name
Last Name
*
Street Address
*
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
*
Phone Number
*
Email Address
*
Emergency Contact Information
Name
*
Relationship
Phone Number
*
Street Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
Email Address
Continuing Education Course
Continuing Education Courses (select all that apply)
*
Online Hazardous Materials Endorsement (starts every Monday)
Passenger Endorsement (starts every Monday)
School Bus Endorsement (starts every Monday)
CPR - BLS For Healthcare Providers- JULY 2024
CPR - BLS For Healthcare Providers- TBD 2024
Phlebotomy Technician
Nitrous Oxide Administration
8 Hour ICC Journeyman & Master Level Mechanical Test Prep
4 Hour ICC Code Based Continuing Education ONLY
8 Hour IPC Journeyman & Master Level Plumber Test Prep
4 Hour IPC Code Based Continuing Education ONLY
12 Hour Manual Lathes Continuing Education
Supragingival Scaling
BLS For Healthcare Providers CPR - TBD
I agree to pay this course's price of:
*
Online Hazardous Materials Endorsement $75
Passenger Endorsement $75
School Bus Endorsement / Passenger Endorsement $75
BLS For Healthcare Providers CPR- $35
Phlebotomy Technician $866.95
Phlebotomy Technician ($100 deposit to hold spot) Pay full balance by
Nitrous Oxide Administration - $226
8 Hour ICC Journeyman & Master Level Mechanical Test Prep $270
4 Hour ICC Code Based Continuing Education ONLY $160
8 Hour IPC Journeyman & Master Level Plumber Test Prep $270
4 Hour IPC Code Based Continuing Education ONLY $160
12 Hour Manual Lathes Continuing Education
Supragingival Scaling $900
Supragingival Scaling ($200 deposit to hold spot) Pay full balance by April 30
Please provide a picture of your DL:
*
Drivers License Number:
*
OSHA 10 Verification - for Manual Lathes Continuing Ed only
Date of Birth:
*
+
Payment Type
*
PayPal - Credit or Debit (Do not have to have a PayPal account. Can pay as a guest.)
Check or Cash - Mail or Bring Check/Cash to College - Check or Cash must be received by first day of class. Exact amount only. No change will be able to be provided.