A.C.I. Career College
2412 McHenry Ave, Modesto, CA  209.338.6224 or 209.338.9224 FAX
PROSPECTIVE STUDENT INFORMATION AT A.C.I. Career College
First Name:
Last Name: MI
Address1:
Address2:
City:
 Zip:
Country:
Home or Cel Phone:
Day Phone:
Email: <<enter valid e-mail address
Re-enter Email: Please confirm your e-mail address. The verification e-mail does not match the e-mail that you entered above.
Birthday: Enter as mm/dd/yyyy
MaritalStatus:
Citizen:
yes no
Course of Interest:
Medical Clinical Assistant Therapeutic Massage Pharmacy Technician
Medical/Dental Admin Assistant Medical/Dental Receptionist Billing and Coding
Phelbotomy Online Courses Financial Aid
Employment Opportunities
What start date are you considering?
  (Classes shown are for Modesto)
  Medical Clinical Assistant
 
2010 Courses [Open Enrollment-Courses Start Weekly] 2011 or Later
  Therapeutic Massage
 
2010 Courses [Open Enrollment-Courses Start Weekly] 2011 or Later
  Pharmacy Technician
 
2010 Courses [Open Enrollment-Courses Start Weekly] 2011 or Later
  Medical / Dental Admin Assistant
 
2010 Courses [Open Enrollment-Courses Start Weekly] 2011 or Later
  Medical / Dental Receptionist
 
2010 Courses [Open Enrollment-Courses Start Weekly] 2011 or Later
  Billing and Coding
 
2010 Courses [Open Enrollment-Courses Start Weekly] 2011 or Later
  Phlebotomy
 
2010 Courses [Open Enrollment-Courses Start Weekly] 2011 or Later
Why have you chosen a
career in Health Care?
 
How did you hear about A.C.I. Career College?:
Did you visit or consider other schools?:
yes no
If so which ones?:
Education  
High School or GED: Year Graduated or will graduate:
College:
Degrees Earned:
Special Interests:
Occupation:
Telephone:
Supervisor:
Can we call this person as a reference: yes no
References:  
#1 Name:
Phone:
 Relationship:
 
#2 Name:
Phone:
 Relationship:
Additional Info or
Considerations:
I would like to receive periodic news about A.C.I. Career College via email.
Please place me on your mailing list for printed materials about A.C.I. Career College.