Pre-Licensing Course Fee Payment Form

Pre-Licensing Course Fee Payment Form
Complete this Pre-Licensing Course Fee Payment Form to provide your details and submit your course fee. All fields are required for enrollment.
Full Name
First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mailing Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Select Course Fee
prevnext( X )
Pre-Licensing Course Fee
Required fee for enrollment in the pre-licensing course.
$350.00

Total
$0.00
Last 4 Digits of Payment Method
Should be Empty: