CNA Student Registration Form

  • CNA Student Registration Form

    Provide your details, credentials, and signature to secure your registration for the Certified Nursing Assistant programs.

  • Student Information

  • The Workforce Board (the state agency that regulates this school) requires that we ask you for this information, by law (RCW 28C.10.050). Providing your social security number is voluntary. By law, the information you provide on this form cannot be given out by any state agency as public information. The Workforce Board will not disclose data to anyone except authorized Workforce Board employees or contractors working on specific research activities, who follow strict confidentiality procedures. This format follows the information required to be submitted by the school as part of the annual student data report.

  • Format: (000) 000-0000.
  • Date of Birth*
     - -
  • Type a question*
  • Are you Hispanic in origin?*
  • Sex*
  • Are you Disabled?*
  • Are you a military veteran?*
  • Employment Status*

  • Student Information

  • Are you 18 years of age or older?*
  • Are you able to pass a criminal background check?*
  • Are you Applying for HCA-CNA Bridge or CNA Traditional (3 Weeks) Program*

  • CNA Traditional Program

  • You are Applying for CNA Programs: Tuition fee is $950 plus taxes. Non-refundable registration fee of $50 is included in the tuition fee and must be paid upon completing this registration form. The remaining tuition balance is due one week before the class start date, and if paid in 2 instalments a $20 service fee is added to the fees and the other half is due by the 7th day of class.

  • Choose your CNA Start Date*

  • HCA-CNA Bridge Program

  • You are applying for the HCA-CNA Bridge Program which requires Active WA HCA License. HCA-NAC Bridge Program has no installment payment. Tuition fee is $650 plus taxes. Non-refundable registration fee of $50 is included in the tuition fee and must be paid upon completing this registration form. The remaining full tuition fee is due one week before the class start date.

  • Choose your CNA Start Date*

  • Admission Requirements

  • To enroll in the Nursing Assistant Certification (CNA) Program, students must meet the requirements and agree to provide required documents.

  • Electronic Signature Requirements

    By checking the boxes below, I certify that I have read & I do meet the requirements of the program and that the information provided is accurate and true to my knowledge.
  • Date of Signature - Must be on the same date you are completing this form.*
     - -

  • Final Step: select and complete the registration fee below.

  • My Products*

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    Registration Fee (Deposit). This is a non-refundable registration fee that secures your seat in this course.
    Registration Fee (Deposit)

    This is a non-refundable registration fee that secures your seat in this course.

    $50.00$50.00
      
    Subtotal
    $0.00$0.00
    Tax
    $0.00$0.00
    Total
    $0.00$0.00

    Payment Methods

    creditcard
    After submitting the form, you will be redirected to Apple Pay to complete the payment.
    After submitting the form, you will be redirected to Google Pay to complete the payment.
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