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.

Section 1. Applicant Information
Section 2. Program
Section 3. Previous Formal Academic Education
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.
Section 4. Major Employment History
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.
Section 5. Personal Recovery Program (if applicable)
If applicable, please indicate any / all programs of personal recovery in which you are currently or were involved (please select all that apply).
Section 6. Payment Method
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.
Section 7. Statement of Intent
Please provide a short autobiography and statement about why you wish to enroll in the program you have selected.
Section 8. Supporting Documentation
Please provide us with the following: 1. Proof of High School Diploma, or GED, or completion of higher education (such as college transcripts); and 2. 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. If applicable, please 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 provide these documents by uploading them here, or by sending to us by email, facsimile, or postal mail.


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

Section 9. Registration Fee Payment
You may pay the $75 Registration Fee by providing your credit card payment information, below, or by mailing us a check or money order. We will process the credit card payment as soon as possible, typically within one business day. We will not commence review of your application until we have received the Registration fee payment.

You give permission to and authorize Breining Institute to charge $75 to the following credit card:


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.