Health Careers Training Institute

    General Enrollment Application

    Program & Start Date

    Applicant Personal Information

    Required Document Uploads

    Social Security Card Copy *PDF, JPG, PNG, DOC
    Government Photo ID (DL/Passport) *PDF, JPG, PNG, DOC

    Background & Education Verification

    Referral & Payment Options

    Clinical Requirements & PPD/TB Test

    Required Digital Touchpad Signatures (5 Required)

    1. Payment Agreement & Collections ProcedureView Agreement ↗
    ✍️ Touch & Draw Signature Here (Touchpad / Mouse / Finger)
    Auto-dated: 2026-10-13
    2. Acknowledgement & Refund Policy AgreementView Agreement ↗
    ✍️ Touch & Draw Signature Here (Touchpad / Mouse / Finger)
    Auto-dated: 2026-10-13
    3. Acknowledgement of KCPE Complaint ProcessView Agreement ↗
    ✍️ Touch & Draw Signature Here (Touchpad / Mouse / Finger)
    Auto-dated: 2026-10-13
    4. Kentucky Student Protection Fund (KRS 165A.450)View Agreement ↗
    ✍️ Touch & Draw Signature Here (Touchpad / Mouse / Finger)
    Auto-dated: 2026-10-13
    5. Statement of UnderstandingView Agreement ↗
    ✍️ Touch & Draw Signature Here (Touchpad / Mouse / Finger)
    Auto-dated: 2026-10-13

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    App Fee & Required Checkout

    $150 App Fee (+$50 if Payment Plan selected). Submitting will open Stripe Checkout.

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