Medical Terminology Program Application

Please complete the below form to apply for the Medical Terminology Program with CanScribe.

Step 1 of 3

Your Profile

First Name(Required)

Last Name(Required)

Email(Required)

Phone(Required)

Gender(Required)

Date of Birth(Required)

Citizenship(Required)

Are you an international student?(Required)

How will you be attending this program?(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Program Information

Proposed Start Date(Required)

Medical Terminology	Certificate
Program Name	Credential Issued	Start Date	End Date
150	16	Distance	English
Program Duration (Hours)	Program Duration (Weeks)	Program Delivery Method	Language of Instruction

Additional Information

I agree that I am running a computer with Windows 10 or newer.(Required)

Did someone refer you to this course?(Required)

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Program Package

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Credit Card

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Pre-Authorized Payments

Application Fee

Price:

Tuition

Price:

Total

PAYMENT TERMS

Payment is due on or before the student's start date.

Document Review

Student Handbook CanScribe Policies PTIB Policies

Government ID(Required)

Max. file size: 400 MB.

Please upload a copy of your government ID to confirm your identity.

Private Training Institutions Branch

Tel. (604) 569-0033 or 1-800-661-7441 Fax. (778) 945-0606

www.privatetraininginstitutions.gov.bc.ca

PTI@gov.bc.ca

Please be advised that under section 61 of the Private Training Act, the Registrar is authorized to collect, use and disclose personal information in accordance with the Registrar’s regulatory duties under that Act. Accordingly, this institution is authorized to disclose your personal information to the Registrar for regulatory purposes.

Student Information


Name	Signature	Date

CanScribe Representative Information


Name	Signature	Date