College Application for Admission


Please use this Application for Admission to apply to Breining Institute certificate programs.

We will not commence review of your application until we have received the non-refundable $75 Registration fee payment. You may authorize the charge to your credit card by providing your credit card information at Section 9, below, or you may send us a check or money order by postal mail after you have completed and submitted this application.

Application / Enrollment Periods

Addiction Studies Certificate (ASC) Program:

The ASC course is an open-application / open-enrollment program, to which you may apply and start at any time. You may apply for this course today using the form below.

Instructions *

Please complete this online form carefully and completely

  • In order to process your application in a timely manner, we will need all of the information requested, as well as all of the applicable documentation.
  • To submit qualifying documentation, you may do so by uploading those documents using this online application. You may upload one PDF document per upload, which must be no larger than 5 MB. If you are unable to upload the document, please send it to us by email, FAX or by postal mail.
  • Or, if you are unable to or would rather not upload your documents using this online form, you may sent it to us separately by email, FAX, or by postal mail:
    • Email: administration@breining.edu
    • FAX: 916-987-8823
    • Mailing Address: Breining Institute, 8894 Greenback Lane, Orangevale, California USA 95662
Program

Applicant Information *

Applicant Information

Please provide us with a copy of a government-issued identification (ID) card, such as a drivers license or passport. Use the upload option below, or send to us by email or postal mail. Do not send by facsimile.

You may upload one PDF document here, which must be no larger than 5 MB. If you are unable to upload the document, please send it to us by email or by postal mail.

Background Information *

In this section, you will be providing background information about yourself, and will be uploading applicable documentation. You may upload the requested documents using the buttons on this page, or you may send us the documents by email, FAX or postal mail, using these addresses below:

Administration@Breining.edu

Breining Institute – Admissions Office, 8894 Greenback Lane, Orangevale, California 95662-4019

916-987-8823

PLEASE NOTE: Your driver license or other government-issued photo identification may not be sent by FAX. It must be sent by using the link on this page, by email, or by postal mail.

Previous Formal Academic Education
Proof of High School Diploma, or GED, or completion of higher education (such as college transcripts). Please identify the formal education institutions that you have attended, and include the certificates or degrees that you were awarded (if applicable). You will also need to provide us with formal transcripts from these institutions before we can complete your enrollment and/or award of any certificate or degree.
Please list here the names of the formal education institutions that you attended, and include the certificates and/or degrees you earned from those institutions, as well as the dates that they were earned.
You may upload one PDF document here, which must be no larger than 5 MB. If you are unable to upload the document, please send it to us by email, FAX or by postal mail.
Please list here your major employment history, especially including your experience within the healthcare field, and include the name of your employer and your job description.
If applicable, please indicate any / all programs of personal recovery in which you are currently or were involved (please select all that apply). Also provide us with a Letter of Support from a Sponsor verifying a minimum of two years sobriety, if you are in recovery.
You may upload one PDF document here, which must be no larger than 5 MB. If you are unable to upload the document, please send it to us by email, FAX or by postal mail.
Colleague Letter of Support
Please provide us with a Letter of Support from a colleague, co-worker or supervisor, confirming your interest in this profession and your readiness to complete this course of study.
You may upload one PDF document here, which must be no larger than 5 MB. If you are unable to upload the document, please send it to us by email, FAX or by postal mail.
Please provide a short autobiography and statement about why you wish to enroll in the program you have selected.

Payment Information *

Please let us know if you intend to make tuition payments by Series or Courses, or if your employer, insurance company or other entity will pay for your tuition. We will need an Authorization to Bill (or similar documentation) if your employer, insurance company or other entity will be paying for your tuition.
If you will be paying the Registration Fee online, you will be directed to a credit card payment page after you have selected the "Submit" button, below.
Attestation

By submitting this form, I attest that the information I have provided above is true and authentic. I understand that if at any time it is determined that the information provided is materially misrepresented, any fees which have been paid will be forfeited, and certifications, degrees and/or credentials may be revoked.

Signature is required.
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