EmailMeForm
Clackamas Nursing Assistant Training Application
Please review the costs, schedule, and policies prior to completing an application.
First Name
*
Last Name
*
Street Address
*
City
*
State
*
Zip Code
*
Email
*
Phone
*
###
-
###
-
####
Checkbox Grid
*
Yes
No
Is English your primary language?
If NO, what is your primary language?
How do you prefer to be contacted
*
Yes
No
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 - Feb 10 - Mar 12, 2025
Class #45 - Mar 24 - Apr 22, 2025
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 and a background check.
I am able to speak, read, write, and understand the English language.
I understand that, if selected for the class, I must attend every scheduled day. If I must miss a classroom/lab day due to an emergency, I will be required to make up the missed time at a rate of $30 per hour.
I understand that there is no make-up day for the clinical portion of the course.
I understand that I must complete the Basic Life Support CPR course, which is not included in the tuition.
Image Verification
Please enter the text from the image:
[
Refresh Image
] [
What's This?
]
