Choffin Adult Career Center logo

Admissions: 330-744-8720 Adult Ed Department: 330-744-8723
200 E. Wood St. Youngstown, OH 44503

Admission Application

Welcome to our new online application. Please complete each section of the form. Once you submit the form you will be directed to make the online payment, After payment, please wait to see our 'Thank You for Your Registration' page before closing.
You can also download and print the form if choose using the link below.

If you choose, you can also download and print the application. Click to Download PDF Version
You will need to contact the office for payment.

Online Admission Application Form

Instructions: Answer all questions. There will be a $50.00 Nonrefundable Registration and Testing Fee for Dental Assisting, Practical Nursing and Surgical Technology while $30.00 for Central Service Technician (CRCST) by submitting this form.

Personal Information

Program of Interest

All programs require the TABE entrance exam that has a non-refundable fee of $20.00 paid at the time of testing.

Educational History

Colleges or Post-Secondary Programs you have previously attended:

Funding Information:

Employment Data:

Emergency Contact:

Additional Information:

Reporting Information:

(The following information is required for State, Federal and accreditation reporting. This information will only be used for statistical reporting requirements.)

Authorization for Release of Information and Applicant Certification:

I hereby authorize the release of information to Choffin Career and Technical Center including information both oral and/or written regarding my records, character, conduct and performance. I understand that all pre-entrance requirements must be met and a criminal background check and satisfactory drug screen are required for participation in each program and clinical externship. I further certify the information given on this application is true.

Status: Empty Signature!

After signing, remember to click the Save Signature button.

For Payment Details:

Total amount due(USD):

--

© Choffin Adult Career Center All rights reserved • powered by iMprivacy policy