Coastal Career Academy

Enrollment

Use the Online Admission Agreement Form on this page to enroll for one of our classes.

You may also come by the school to register!

To secure your spot, a non-refundable administrative fee is charged on all applications.

Once we receive your application we will follow up with a phone call.

REFUNDS

Massachusetts state laws determine how refunds are to be handled if a registered student withdraws. You will be refunded all payments if:

There are no vacancies in your selected course
The course is cancelled
You cancel in writing within five (5) days of registering before the classes start.
After 5 days of registration or if classes have begun, any cancellation will result in an Administrative Fee. Once class starts, there is a withdrawal charge of 25% of course costs, plus book costs and an Administrative Fee during the 1st quarter. After 1st quarter, withdrawal results in additional fees.

This Form Is Secured

Online Admission Agreement

Applicant Information

* First Name:

Middle Initial:

* Last Name:

* Phone:

* Email:

Social Security Number:

* City:

* State:

* Zip Code:

* What is your interest?

If other, please specify:

* To which program are you applying?

Day program
Evening program
Online program

* Are you a citizen of the United States?

Yes
No

If no, are you authorized to stay in the U.S.?

Yes
No

* Have you ever applied for admission?

Yes
No

If so, when?

* Have you ever been convicted of a felony?

Yes
No

If so, explain:

* Have any of your friends or relatives attended Coastal Career Academy?

Yes
No

If so, when?

How did you hear about the Academy?

If other, please specify:

Education

Proof of Education: Medical Assistant and Medical Office Assistant and Phlebotomy applicants are required to provide official documents, transcripts, and GED results. Please contact us to arrange for mail in or drop off. Or,if you have electronic copies you can send via email to coastalcareer@comcast.net.

Name of high school attended:

Date of Attendance

Start Date:

End Date:

Address:

City:

State:

Zip Code:

Phone:

Email:

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge. If this application leads to admission, I understand that false or misleading information in my application or interview may result in my dismissal from the program. This application and all supporting documents become the property of Coastal Career Academy and will not be returned to you or sent to another institution. All candidates for admission to Coastal Career Academy are considered on individual merits, without discrimination on the basis of age, creed, national and ethnic origin, race, color, sex, gender/sexual orientation, marital status or disability.

Electronic Signature

By checking the following box you are stating that you have read and understood the information in this application. This checkbox serves as your Electronic Signature.

* What is your interest?

Yes, I agree this checkbox serves as my signature.