SECTION 1: Select Your Training Course. To enroll in a combination course, simply check all of the courses you want to include, or check "All Courses" for the Ultra Combination: Medical Transcription Medical Coding Medical Billing Medical Office Assistant Medical Office Manager Legal Transcription Paralegal/Legal Assistant All Courses - Ultra Combination	SECTION 2: Your Name and Contact Information: First Name: Middle Name or Initial: Last Name: Street Address: City: State: Zip Code: Daytime Phone: Evening Phone: Email Address: Best Time To Call You: 9 AM - Noon Noon to 5 PM Any time between 9 AM and 9 PM Your Time Zone:
SECTION 3: Current Employment Status: Currently Working Full Time Currently Working Part Time Currently Unemployed	SECTION 4: Employer Contact Information If currently unemployed, list your last most recent employer: Employer Name: Employer Address: Employer City: Employer State: Employer Zip Code: Employer Phone:
SECTION 5: Personal References #1: REFERENCE 1: Full Name: Address: City: State: Zip Code: Phone:	SECTION 6: Personal References #2: REFERENCE 2: Full Name: Address: City: State: Zip Code: Phone:
SECTION 7: Co-Signer Status: (Check One) -- NOTE: If your credit score is below 620, you will have a better chance of getting approved and you may also obtain a lower interest rate, if you use a co-signer. If you have not considered a co-signer, just indicate which option is most likely: I will not use a co-signer I will use a co-signer only if necessary Personal Reference 1 will be my co-signer Personal Reference 2 will be my co-signer I have someone else willing to co-sign and will provide that information during the follow-up interview.	SECTION 8: Acknowledgement: Verification Is Required... I do hereby certify that I am at least 18 years of age, and that I am a U.S. Citizen or Legal U.S. Resident living within the United States or its Territories. I understand that the information provided here is not a guarantee of a loan, and that additional information may be required in order to process a Sallie Mae Loan Application. I do hereby authorize Meditec.com (its representatives) to act on my behalf to process the information submitted herein, for the purposes of applying for a Sallie Mae Student Loan, which may include the need for a credit check, and for which I agree to provide my a copy of my Drivers License, State ID Card, Social Security Card, and/or other proof of identification as may be needed upon request.

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