Contact Us - Ohio Institute of Health Careers

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* What prompted you to contact Ohio Institute of Health Careers today?
What benefits are important to you and will help you decide where to pursue your new career?
* Campus Location:
* Program of Interest:
What time of day would you prefer to attend classes?
What motivated you to continue your education?

Basic Information
* First Name:
* Last Name:
* Address:
* City:
* State:
* Zip Code:
* Phone Number:
* E-mail Address:

* What is your education level prior to beginning classes at OIHC?
* What is your current age?
What is your gender?

Male

Female

Employment Are you currently employed?

Yes

If yes, what kind of work do you do?
If you are currently employed, do you work full-time or part-time?

Full-time

Part-time

Know someone who might be interested in OIHC?

Many of the most successful students will attend school with someone they know. Do you know anyone who may also be considering a change in career?

Name:
Telephone:
Relationship:

Additional Questions or Comments

I understand by submitting this application for admission that I have not been accepted to the school or in the program identified above. Also, I understand that once my application has been received and reviewed, I will be personally contacted to schedule my admissions interview where I will have the opportunity to provide additional information that may help strengthen my application for admissions.

* We respect your privacy! Your contact information will never be used for any purpose other than the School contacting you.

Ohio Institute of Health Careers

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