Techni-Pro Institute

414 NW 35th Street, Boca Raton, Florida 33431

TPI Application Form

This application must be accompanied by a $75.00 non-refundable registration fee.

STUDENT INFORMATION

Emergency contact

Student Employment Verification

NOTE: Section 1001 of Title 18 of the U.S. Code makes it a criminal offense to make willful false statements or misrepresentations to any Department or Agency of the United States as to any matter within its jurisdiction.

Program Application Form

The following items are required in order to be considered for admission to the program: 1.Proof of a high school diploma, GED, or validated foreign equivalent 2.Copies of any post-secondary certificates of health-related course taken (CORE, PCT, PCA, HHA, Medical Terminology, CNA, and MA). 3.Official transcripts of college degrees no later than 2 week of start date. 4.A copy of your FL driver license 5.A copy of your Social Security card 6.FDLE-Level 2 Background screening

The following documents should be submitted through email to tpi.docs@technipro.com * High School Diploma or GED * Transcripts * Driver License * Social Security Card

RN License Number

Note: If you have taken the TEAS/ KAPLAN/ ATI or HESI Test at an approved school within the past two years, you should request the school to send a copy of your scores to Techni Pro Institute.

Release of Information

In conformance with 20 U.S.C. 123g (Family Education Rights and Privacy Act) and Section 228.093, Florida Statutes, I authorize Techni Pro Institute and its agents to release and disclose the information contained in this form, including my immunization record, upon request, to a clinical affiliation site I herein give permission to duplicate the requested information and release it to the clinical site. I do not give permission to duplicate the requested information and release it to the clinical site.

Declaration

Required