Apply | Majestic Technical Institute

Name *

Date of Birth *

Last 6 Digits of Social *

Gender *

Male
Female

Mailing Address *

Phone Number *

Email address *

Branch Location *

Byram, MS
Ackerman, MS

Program (Please check) *

Certified Phlebotomy Technician
Certified Clinical Medical Assistant
Certified Pharmacy Technician

Program Start Date *

Form of Payment ($100 NONREFUNABLE REGISTRATION FEE) *

Cash App
Venmo

Proof of Financial Status *