Please fill out the following form:

Section I - Personal Information


Please indicate which test preparatory course you want to enroll:








SAT Yes    No    Online
GRE Yes    No    Online
GMAT Yes    No    Online
TOEFL Yes    No    Online
NCLEX/CGFNS Yes    No    Online
USMLE STEP 1 Yes    No    Online
USMLE STEP 2 Yes    No    Online
USMLE CSA Yes    No    Online
NCLEX EXAM Online Yes    No    Online
Have you taken this exam(s) before? Yes    No
First Name:
Last Name:
Date of Birth: / /           Age:
Gender: Male    Female
Mailing Address:
City/State/Zip:
Email Address:
Occupation:
Work Phone:
Home Phone:
Best time to call:
   
Citizenship:
Do You Have A
Valid Passport?		 Yes    No
Passport Number:
   
Program Start Date: / /
Program End Date: / /
Are you a Ghanaian Resident? Yes    No
If not a resident, have you been to Ghana? Yes    No
If yes, indicate
purpose of previous
trip:
   



Section II - Program Placement Information

Level of Education:
Most recent University, College, of SSS (High School) graduated from and location:
Degree or Certificate, and date:
Professional Experience:
List previous int'l
travel experience:
   
   
List course dates
in order		 (1)    
of preference:
 		 (2)    
(3)    
Reason for
taking courses:
How did you hear
about this program?



Section III - Personal References

(3) References/Phone:
 
 
   
   
  I certify that the information provided in this form is correct.
 




[2006 - 2007]

SAT, TOEFL, GRE, GMAT, CGFNS/NCLEX

   Apr 02 07-May 25 07

USMLE Step 1

   Apr 02-JUN 01 07

USMLE Step 2 & CSA

   JUN 11 07-AUG 10 2007