The New York School Pre-Enrollment Form

Note: The information you submit will remain confidential and does not represent a commitment on your part to attend The New York School or an obligation on our part to accept an application from you if submitted. The information provides us a picture of your interests and needs. It is intended to help you fast-track your admission to The New York School.

First Name	*
Last Name	*
Mailing Address	*
Apt. No.
City	*
State	*
Postal Code	*
Home Phone	*
Work Phone
Cell Phone
E-Mail	*
2. I learned of The New York School for Medical and Dental Assistants initially from: Radio TV Internet Referral Subway Direct Mail Yellow Pages Daily News Other Newspaper
3.* I am most interested in the: Medical Assistant Program Dental Assistant Program Please Check One Full time student Part time student Please Check One
4. I am attracted to this field because I would like to: Be in a profession that helps people Have a career with a long-term future Earn more money Have a better life overall
5. U.S. Citizen? Yes No, but I am an eligible non-citizen with an alien registration number No, but I have a valid work permit
6. I have: Neither a HS Diploma or GED but am in the process of attaining it A High School Diploma or GED An Associates Degree or other college degree
7. I am currently: Employed Full-Time Employed Part-Time Not Working
8. I am thinking about getting started in training for my new career: Immediately In about 3 months In about 6 months In one year
9. When I have my personal interview, I would find it helpful to learn more about: Job placement services Financial aid options When I can get started What I can expect to earn after graduation Career outlook and benefits
10.* The best time for me to visit the school and have my personal interview is: Morning Lunch-time Afternoon Evening Please Check Also Monday Tuesday Wednesday Thursday Friday Please Check Also After your Time(s) and Day(s) of week are complete, please check here
* Required Field Thank You For Your Time!

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© 2008 The New York School for Medical & Dental Assistants