CARLEEN HEALTH INSTITUTE OF SOUTH FLORIDA

PAYMENT (PLEASE PLACE #1 BY YOUR SELECTION)

Date * +

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Email Address *

Phone Number *

Are you a current student *

yes

no

What campus do you attend *

Plantation

WPB

Palm Bay

What is your current subject/class *

COURSE TITLE

	Anatomy
	Pharmacology
	Nursing process 1
	Nursing process 1 Clinical
	Nursing process 2
	Nursing process 2 Clinical
	Medsurge 1
	Medsurge 1 Clinical
	Maternity
	Maternity Clinical
	Psych
	Psych Clinical
	Pediatric
	Pediatric Clinical
	Medsurge 2
	Medsurge 2 clinical
	Medsurge 3
	Medsurge 3 clinical
	Trends
	Trends Clinical

New Enrollment

	Entrance exam fee
	Application fee
	Enrollment Fee
	Uniform fee
	ID badge fee

HESI SPECIALTY EXAM

	PHARMACOLOGY
	FUNDAMENTAL
	MATERNITY
	PSYCH
	PEDIATRIC
	MEDSURGE
	EXIT

EXPEDITE HESI PRIORITY TESTING IF YOU WANT TO TEST WITHIN 24 HOURS $20.00 PROCESSING FEE

YES ($20.00)

NO

Expedite Priority Testers only: Pick the Date then in the note section to school below type the time. All time must be between Monday to Thursday 9-2 pm +

Note to school

Payment Information

Date of Payment * +

*

you must have at least one item