Admissions

Student Application Form

Complete the information below to begin your application to ACTIVA Training Center.

Course Name:

HOME HEALTH AIDE (75 Hr.) PROFESSIONAL NURSING PROGRAM (76 Cr.)

ACTIVA TRAINING CENTER

Main Campus

9580 Bird Road 2nd Floor Ste. D
Miami, FL 33165
Phone: (786) 615-3790

Satellite Location

10720 W. Flagler Street #20 & 21
Sweetwater, FL 33174
Phone: (786) 409-7240

Email: info@activatrainingcenter.edu

Licensed by the Commission for Independent Education, Florida Department of Education. Additional information regarding this institution may be obtained by contacting the Commission at 325 West Gaines Street, Suite 1414, Tallahassee, FL 32399-0400, toll-free telephone number (888) 224-6684, License No. 5829.

Student Information

Last Name:

First Name:

Middle Initial:

Address:

Apt #:

City:

State:

Email:

Zip Code:

Telephone:

SSN (last 4 digits):

Date of Birth:

Marital Status:

Emergency Contact

Emergency Contact:

Relation:

Telephone:

Contact Address:

Apt #:

City:

State:

Zip Code:

Background & Education

Are you a citizen of the U.S.A.?

Have you ever been convicted of a felony?

Are you employed now? If so, specify:

Employer name:

Position:

Since:

Do you have a high school diploma? If so, date received:

School Referral Information

Tell us how you know about the school.

Source Referral:

How did you hear about the school?

Application Status

Has this application been officially denied? If denied, explain why:

Signatures

Applicant's Signature:

School Representative:

Your Future Starts Here

Ready to Take the Next Step?

Start your journey at Activa Training Center. Explore your program options, submit your application, or connect with our team if you have questions about getting started.

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