Admissions Application Request - Main Form

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Welcome to Orlando Medical Institute...... We are happy to have you join our Team #TeamOMI. Please complete this enrollment form and someone from Student Services will be in contact with you with what's next!!!

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First Name
Middle Name
Last Name
Email Address
Social Security Number
Date of Birth
Gender
Hispanic
Ethnicity

White

Black or African American

Asian

American Indian or Alaska Native

Hawaiian or Other Pacific Islander
Citizenship Status
Marital Status

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Address & Phone Number(s)
Street 1
Street 2
City
State
Zip Code
US Emergency Phone Ext:
Home Phone Ext:
US Cell Phone Ext:

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High School (or GED center) attended
Post-Secondary Institution Attended
Post-Secondary Institution Attended
Program of Interest
Start Date
Disability
Are you a Veteran?

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How did you hear about the school?
Uniform Polo Shirt Size
Uniform Scrub Top Size
Uniform Scrub Bottom Size
Upon clicking the submit button, you will be redirected to your payment page. Payment is required to complete your initial enrollment. The institute accepts online payment and/or in-person payment with a member of Student Services.

Orlando Medical Institute

6925 Lake Ellenor Drive
Building 3
Orlando, FL 32809
(407) 251-0007
info@omi.edu