Application for Admission 2NP(a)

Phone Numbers


City, State, Country

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*If you qualify for any of these programs we may be able to assist you with locating and applying for tuition funding

(FAFSA is the Free Application for Federal Student Aid)

Medical Employment

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Other Employment Information

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Medical Training

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Other Educational Background:

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Career Goals

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Emergency Contact Information

Emergency Contact 1 Information

Emergency Contact 2 Information

Bay Area Medical Academy reserves the right to require a physician’s approval if it determines that any past or current illnesses or injuries (physical, mental, emotional) would in any way hinder the student’s successful program completion.

If you have served in the U.S. Armed Forces, please provide the branch of service and approximate dates of military service:


Military Services

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Please be reminded that having a criminal background may prohibit your employment efforts in the healthcare field. It is your responsibility to verify whether your criminal background will affect your chances of obtaining a California State License of Phlebotomy. Please ask an Admissions Representative for the appropriate contact information.

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Students with special needs due to disability should advise the Academy prior to enrollment to assure that reasonable accommodations can be made to facilitate training. Please describe your needs.

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Bay Area Medical Academy reserves the right to deny admission to any applicant who does not demonstrate the ability to benefit from the training program.

Bay Area Medical Academy does not discriminate on the basis of Race, Color, National Origin, Sex, Handicap, or Age in employment, admissions or any of its educational programs or activities.

IF YOU ARE UNDER 18 YEARS OF AGE YOUR PARENT OR GUARDIAN MUST ALSO SIGN THIS APPLICATION.

Scrub Order

Sizes are unisex.

Scrub sizes are one size bigger and only come. Please Add in one size sets. Once scrubs are opened you cannot return.
Required