EmailMe Form - Clackamas Nursing Assistant Training Application

First Name *
Last Name *
Street Address *
City *
State *
Zip Code *
Email *
Phone *
### - ### - ####
How do you prefer to be contacted *

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I will respond to text messages

I will respond to Email messages

I will respond to voice or voicemail
Please select the class dates you wish to attend. *
Class #44 - Classes for 2025 will display here very soon
Please enter any questions or comments you may have:

You MUST answer the following questions: *

	Yes	No
I understand that completing this application does not guarantee me admission into the program.
I understand that I will be asked to submit to a drug screen.
I understand that I must submit to a criminal background check.
I am able to speak, read, write, and understand the English language.
I understand that I must complete the Basic Life Support CPR course, which is not included in the tuition.

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