The Parlor Institute of Clinical Readiness™

Enrollment Application

Complete all four sections of this intake form. Upon submission you will be directed to pay the $150 non-refundable enrollment deposit to secure your seat in the September 28, 2026 cohort.

Enrollment Deposit$250Non-refundable · Applied to tuition

Step 1 of 4

Personal Information

Program Selection

Which program are you applying for?

Accelerated MA Clinical Readiness6 weeks · $350 tuition · $150 deposit

MA Clinical Bridge Certificate4 weeks · $250 tuition · $100 deposit

Identity

First Name

Last Name

Email Address

Phone Number

Date of BirthMM/DD/YYYY

Mailing Address

Street Address

City

State

ZIP Code