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This application certifies the student is formally requesting enrollment in the CELT program. 

STUDENT SIGNATURE___________________________________________

NAME (print )___________________________________________________

ADDRESS________________________________________________

CITY, STATE ZIP __________________________________________

PHONE _________________________________________

EMAIL _________________________________________________

SOCIAL SECURITY optional ______________________

  CMA doesn't use SS#, it is only for your transcript

PAYMENT (check one)  credit card______  check ______

Fill out application, and mail to CMA with $50.00 administration fee.  When received, CMA will send your CELT book.

Make the check payable to C.M.A. 

If you wish to use a credit card, you may mail the application and CMA will call for your credit card #

CMA

8654 Meadow View Dr.

West Chester, OH 45069