Applicant Information – M1 Enterprises USVI, LLC

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Application

USVI Application form

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email

Phone

Choose Your Program

Medical Biller

Outpatient Coder

Inpatient Coder

Do you have a High School Diploma or Equivalent

Yes

No

If you are interested in Funded programs at no cost to you, please complete the following

High School Diploma or Equivalent

Yes

No

Social Security Card

Yes

No

Last Year's Tax Return

Yes

No

Proof of Physical Address

Yes

No

Proof of Citzenship

Yes

No

Proof of Income

Yes

No

Proof of Selective Service Registration (Males 18-26 years)

Yes

No

Proof of Eligibility to Work in the US

Yes

No

In order to serve you in a timely manner, we ask that you be prepared to submit the above listed documents upon request

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