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Mandl School
The College of Allied Health

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MANDL SCHOOL ONLINE ENROLLMENT APPLICATION

Thank you for your interest in Mandl School. Please fill in all fields below to the best of your ability and submit. You must complete your application in its entirety before you submit as you will not be able to save and return to the application. Once submitted, a Mandl School Admissions Representative will reach out to you shortly. Thank you!

Step 1 of 3 - PERSONAL INFORMATION & PROGRAMS

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PERSONAL INFORMATION
First Name*
Last Name*
Fill out Address in Spaces Below*
Number and Street Name/Apt# City State ZIP Code
Phone: Cell, Home or Work*
Other Phone: Cell, Home or Work
Email*
GENDER*
- FEMALE
- MALE
- NON-BINARY
U.S. CITIZEN*
- YES
- NO
ARE YOU OVER 24 YEARS OF AGE?*
- YES
- NO
PERMANENT U.S. RESIDENT*
- YES
- NO
CITIZENSHIP OF ANOTHER COUNTRY*
Name of country other than USA. If not applicable, please write NA
I WISH TO ENTER MANDL FOR:*
- WINTER (January)
- SPRING (May)
- FALL (September)
MY SCHEDULE CHOICE IS:*
- Select All
- DAY
- EVENING
- WEEKEND
MANDL PROGRAMS
PLEASE SELECT THE PROGRAM YOU WOULD LIKE TO PURSUE*
- A.O.S. IN SURGICAL TECHNOLOGIST
- A.O.S IN MEDICAL ASSISTING
- A.A.S. IN HEALTH CARE ADMINISTRATION
- A.A.S. IN RESPIRATORY THERAPY
- A.A.S. IN DIAGNOSTIC MEDICAL SONOGRAPHY (DMS)
- CERTIFICATE IN DENTAL ASSISTING
- CERTIFICATE IN MEDICAL ASSISTING
INTERESTED IN MORE THAN ONE PROGRAM?
If you are interested in more than one Program, please select your first option above and then select the other program you are interested in below.
- A.O.S. IN SURGICAL TECHNOLOGIST
- A.O.S. IN MEDICAL ASSISTING
- A.A.S. IN HEALTH CARE ADMINISTRATION
- A.A.S. IN RESPIRATORY THERAPY
- A.A.S. IN DIAGNOSTIC MEDICAL SONOGRAPHY (DMS)
- CERTIFICATE IN DENTAL ASSISTING
- CERTIFICATE IN MEDICAL ASSISTING

EDUCATIONAL BACKGROUND
HIGH SCHOOL, TRADE OR TECHNICAL SCHOOLS ATTENDED*
Please list all High Schools and Trade or Technical Schools you have attended. Please tell us the: SCHOOL NAME / CITY & STATE / DATES ATTENDED
DO YOU HAVE A HIGH SCHOOL DIPLOMA OR G.E.D.*
- YES
- NO
HIGH SCHOOL GRADUATION DATE*
COLLEGES ATTENDED*
Please list all Colleges you have attended. Tell us the: COLLEGE & STATE / DATES ATTENDED / DEGREES EARNED. If not applicable, please write NA.
EMPLOYMENT BACKGROUND
WORK EXPERIENCE: LIST LAST 3 EMPLOYERS
List by: EMPLOYER & ADDRESS / POSITION / EMPLOYMENT DATES. If not applicable, write NA

STUDENT REFERRALS
STUDENT REFERRALS
Please write down the name and phone # of friends or relatives who can benefit from an education at Mandl.
ADDITIONAL INFORMATION
HOW DID YOU HEAR ABOUT MANDL?*
- INTERNET
- PRINT/TRANSIT
- REFERRAL
- SOCIAL (Facebook, Instagram, etc.)
PLEASE READ*
Although a credential/licensure is not required by the state, companies may make it a condition of employment, as well as conducting a criminal background check. An applicant should consider and personally evaluate whether or not there are personal circumstances or physical limitations that may adversely impact his or her ability to complete a program at Mandl. I also understand that this application cannot be processed if it has not been completed properly and that all information submitted is true to the best of my knowledge. Accordingly, any deliberate falsification or omission of data may result in a denial of admission or dismissal.
- I HAVE READ THE ABOVE STATEMENT
TRANSCRIPT RELEASE
Please complete all lines below. By submitting this application for enrollment, I give permission for the High School named below to release a transcript of my grades to Mandl School - The College of Allied Health, at 254 West 54th Street, New York, NY 10019
I ATTENDED YOUR HIGH SCHOOL*
Write name of high school and address
I ATTENDED DURING THE YEAR(S):*
Non-Discrimination Policy
Mandl School - The College of Allied Health does not discriminate on the basis of age, color, religion, creed, disability, marital status, veteran status, natural origin, race, gender or sexual orientation, in its educational programs, activities and employment.
MANDL SCHOOL CATALOG AND STUDENT HANDBOOK*
For disclosures and detailed program(s) information, please refer to the Mandl School Catalog & Mandl School Student Handbook located on our website and please confirm that you understand Mandl School has provided you with our School Catalog and Student Handbook.
- YES, I confirm that Mandl School has provided me with the ability to review the Mandl School Catalog and Student Handbook.
Phone
This field is for validation purposes and should be left unchanged.

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Mandl School The College of Allied Health

254 W 54th St , New York, NY 10019

Phone212.247.3434

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