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Please fill out the form below to get in touch with us. We’ll get back to you as soon as possible.

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Name*
First Middle Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Date of Birth*
MM slash DD slash YYYY
Education Information
Highest level of education completed*
Select A Course
Course you are registering for*
Select a course date*
Background Information
Name of current employer
Address of current employer
Employer Email
Employer Phone
Name of Emergency Contact
Address of Emergency Contact
Emergency Contact Phone
Emergency Contact Email
Have you ever been convicted of a crime in the last 7 years?*
Have you ever been discharged or disciplined by an employer for abusing or mistreating a client?*
If you answered yes to either one of the last two questions above please explain below
Upload copies of your High School Diploma or GED and a copy of Hepatitus B vaccination or declination information. Provide evidence of a negative Tuberculosis PPD test or chest x-ray result taken within one year prior to training commencement date, and which indicates tuberculosis clearance
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Max. file size: 32 MB.
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About AMC Career Institute

We believe so much in our students as they have confidence in us to aid them excel over the years. We teach compassion from the heart.