Online Pre Enrolment Form

Online Pre Enrolment Form

The Excelsior Healthcare Academy and Illinois State Board of Education state that all healthcare workers should be held to the highest moral standards and code of ethics. The Excelsior Healthcare Academy maintains the right to deny admission to any course program for good cause.

Reasons for denial of admission may include but are not limited to the following:
1. Application by fraudulent means or through misrepresentation of facts.
2. Physical, mental or emotional incapacity or unfitness.
3. Conviction, a plea of guilty, or a plea of nolo contendere for violation of law punishable as a felony or misdemeanor other than a minor traffic violation.
4. Personal conduct that seriously reduces the applicant’s potential for administering safe nursing care because of conduct detrimental to the health or welfare of others.

 

YOU MUST COMPLETE ALL THE STEPS BELOW TO BE CONSIDERED FOR ADMISSION TO THE EXCELSIOR HEALTHCARE ACADEMY.

  1. Check your preferred course programs online 
  2. Apply to Excelsior Healthcare Academy using the application form below
  3. Print and forward copy of application form, plus all required information to Excelsior Healthcare Academy, either by hand or post.
  4. If after three days, you have not heard from us, you are always advised to follow up with a phone call
  5. Prerequisites for Admission into Excelsior Healthcare Academy Course Program except for First Aid Related Courses
  • Verification of ID (State ID or Drivers License)
  • English and Maths Placement Exam
  • Background Checks
  • Finger Prints

 

You are advised to print a copy of your registration form before you click submit.
Forward a copy of your ID and the application form to the school office.
Your coupon code  (EHA25CNA) will also guarantee you a management discount on CNA and Phlebotomy Technician program (Limited Time Only).

Call the School Office for detailed information.

 

 EHA Online Application Form

 

Excelsior Healthcare Academy offers an open Enrollment throughout the year.

Next Of Kin

Required in case of emergency. Enter only current information.

Education

Enter the most recent education at the top.
Include year, name of college, address and contact number.
Include Name of supervisor, contact number and email address.

Employment & Personal Statement

Why do you want to take this course program, include experience if any, level of commitment, expectations and your future plans after graduation.

Maximum file size: 268.44MB

Upload copy of any required documents.
(Applicable only to CNA & Phlebotomy Course Program). Other coupon codes are available at the management discretion and for EHA Alumni. You will need to open an online account to be eligible.
Enter today's date
You agree that all the information entered is correct. Any misinformation is constituted as fraud and may lead to expulsion from the school. If you are expelled you will not be entitled to any refund. Enter full name as signature.

 

YOU ARE ADVISED TO GO OVER YOUR FORM, VERIFY ACCURACY BEFORE YOU SUBMIT IT.  THANK YOU.

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