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Online Physics Review

The document is an application form for an online physics review program from the Institute of Allied Medical Professions School of Medical Imaging Technology. It requests personal information such as name, address, phone numbers and social security number. It states that non-IAMP students must pay $250 for processing and IAMP students must pay $200. It also requests information on current or past school enrollment and allows the applicant to pay by credit card or check made out to IAMP.

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Myrna Garcia
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556 views2 pages

Online Physics Review

The document is an application form for an online physics review program from the Institute of Allied Medical Professions School of Medical Imaging Technology. It requests personal information such as name, address, phone numbers and social security number. It states that non-IAMP students must pay $250 for processing and IAMP students must pay $200. It also requests information on current or past school enrollment and allows the applicant to pay by credit card or check made out to IAMP.

Uploaded by

Myrna Garcia
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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The Institute of Allied Medical Professions

School of Medical Imaging Technology Office of Admissions 1351 Washington Boulevard, Suite 560 Stamford, CT 06902 T. 203.541.5678 F. 203.358.4756
APPLICATION FOR Online Physics Review PERSONAL INFORMATION 1. 2. Name (Last Name) Address (Street address) (First Name) Phone numbers: (Apt. #) (City) (State) (Zip Code) Business Cell_________________________ Home______________________ Social Security Number / /

Non IAMP students Please enclose payment of $250.00 (check or money order made out to IAMP) required for processing. Mail payment to IAMP at the address above Are you currently in school Y______ N _____ School Name_______________________________________________________ Year(s) Attended ______________________ IAMP Students payment of $200.00 (check of money order made out to IAMP) required for processing. Mail payment to IAMP at the address above. Graduate__Y___ N__Campus_______________________Current Student ___Y___N___Campus_________________________ Or pay by Visa or Mastercard #___________________________________Exp. Date___/___/___/ Sec Code________

I AUTHORIZE WITHOUT RESERVATION, ANY PARTY OR AGENCY CONTACTED TO FURNISH THE ABOVE MENTIONED INFORMATION

Applicant's Signature

Date

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