New Student Enrollment Application

9494 Southwest Freeway Suite 700
Houston, Texas 77074
Tel: (713) 505-1660
apply@hightexas.org
https://hightexas.org/

Student Enrollment Application

NOTE: Terms start every four weeks.
Spring Term 1 begins in January.
Spring Term 2 begins in March.
Summer begins in May.
Fall Term 1 begins in August.
Fall Term 2 begins in October.

Program

Enroll In

Personal Information

Please enter your name as it appears on your passport or other official documents

Last Name

First Name

Middle Name

Sufix {Jr., Sr., etc.}

Cell Phone

Birth Date

Gender

Ethnicity

Primary Language

Secondary Language

Faith/Religion

Social Security No

How did you hear from us

Emergency Contact Information

1. Name

Relationship

Address

City, State, ZIP

Home Telephone

Cell

Work Telephone

Employer

2. Name

Relationship

City, State, ZIP

Address

Home Telephone

Cell

Work Telephone

Employer

Current Mailing Address

Street

City

State/Province

Zip/Postcode

Country

Citizenship

Place of Birth

City/Town State/Province Country

Work Status

Our Goal is to place our graduates in careers in Healthcare. You must be authorized to work in the United States to attend our programs.

Residency Status

Academic Information

High School

City/Town

State/Province

Zip/Postal Code

Country

Are you a High School Graduate or have received a GED?

Yes No Not Selected

Please upload high school diploma or GED

Authorization

Your signature below confirms all information in this application (including any supplemental information) is factually true and honestly presented and that you are the person submitting this application.

Date

Enter the above code

Required