Midwestern University Midwestern University Drug Testing Program: Enroll Now Midwestern University Form Student Name * Student Name First First Last Last Student ID * Student Email Address * Student Cell Phone Number * ZIP Code to Search * ZIP code where student will be located to complete the drug test Program Enrolled in * Select ProgramGraduate NursingOther Programs Tests * Select Drug TestDrug Screen 2 – Panel 23283NDrug Screen 4 – Panel 35140NDrug Screen HonorHealth – Panel 37870NDrug Screen Phoenix Children’s Hospital – Panel 37865N Tests * Select Drug TestPanel 37949N Breath Alcohol Test needed - $50 * Yes No Signature of Enrollee * signature keyboard Clear Today's Date Total Payment * Payment Payment Payment Month 123456789101112 Payment Year 20252026202720282029203020312032203320342035 Payment Billing Address * Billing Address Billing Address Billing Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Submit If you are human, leave this field blank. {{#message}}{{{message}}}{{/message}}{{^message}}Your submission failed. The server responded with {{status_text}} (code {{status_code}}). Please contact the developer of this form processor to improve this message. Learn More{{/message}}{{#message}}{{{message}}}{{/message}}{{^message}}It appears your submission was successful. Even though the server responded OK, it is possible the submission was not processed. Please contact the developer of this form processor to improve this message. Learn More{{/message}}Submitting…
