English as a Second Language?*
Please upload and attach your High School Transcript
Please attach and upload High School Transcript
Emergency Contact/Next of Kin
Emergency Contact: Full name:*
Emergency Contact: Relationship:*
Emergency Contact: Phone #:*
Emergency Contact: Address:*
Program of Interest?*
What is your desired start Year and Month.
We will confirm your actual start date based on the registration process completion.
Desired Start Date
High School Grad Date
Higest Level of Education*
By submitting this form, I agree that Atlantic College of Applied Health Sciences may call, text and/or email me about their educational services