Healthcare PRO Interest Form
Kickstart your healthcare career! Build in-demand skills, earn industry certifications, and prepare for healthcare career opportunities. Train for a career as a EKG Technician or Phlebotomist through the Urban League of Greater Atlanta's Healthcare PRO program. For this program you must be: *18 years old or older *Have a high school diploma/GED *City of Atlanta resident (proof of residence with a Driver's License or State ID with a city of Atlanta address) Program length: 6-weeks Next Cohort: TBA If you are interested in this program, fill out the interest form and you will be notified when recruitment opens.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What county do you live in?
*
Do you live in the city of Atlanta?
*
Yes
No
Age
*
Which program are you interested in?
EKG Technician
Phlebotomy
Gender
*
Please Select
Female
Male
Non-binary
I prefer not to answer
Race
*
Black or African American
Asian
Latinx
White
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
I prefer not to answer
Other
I understand that to be considered for this program, I must be a city of Atlanta resident with proof of residency (driver's license or State ID)
Submit
Should be Empty: