Application Form

Integrity Health and Education Application Form

"*" indicates required fields

1Contact/Course Information

2Upload Documents

Name*

First Last

Date of Birth*

This allows Integrity Health & Education to run a State Level Background Check for enrollment/employment purposes.

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email*

Phone*

Which Program Are You Interested In?*

Hidden

What class date do you want to begin?*

How do you want to cover your course cost?*

Deposit ($450)

Meritize

Dreambound ($350) Third Party Vendor

State Voucher (5-6 Week Approval)