Education Verification Request Form

Address: US
Price range: $$

Student Information

I, , authorize Choffin Career and Technical Center to provide an education background information.

Name while attending Choffin CTC: (required)

Phone Number: (required)

Email: (required)

Date of Birth: (required)

Year of Graduation/Attendance: (required)

Program attended: (required)

Dental Assisting

Practical Nursing

Surgical Technology

Other:

Verifier Information

Verifier Name: (required)

Verifier Address: (required)

City:

State:

Zip: (required)

Verifier Phone Number:

Verifier Website and/or Order Number:

Applicant Name

Status: Empty Signature!

Applicant Signature

After signing, remember to click the Save Signature button.

Date

Contact

Admissions: 330-744-8720

Adult Ed Department: 330-744-8723

200 E. Wood St.
Youngstown, OH 44503

About

Choffin Career & Technical Center offers adults the opportunity to advance in a career in the medical field, with comprehensive courses in Practical Nursing, Dental Assisting, and Surgical Technology. Our Industry Credential Programs develop the professional skills and knowledge the can put you on the right track.

Follow

Facebook

Instagram

Twitter

Admission

Programs

Continuing Ed

Testing

Student Services