• 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*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Race*
  • 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?*

  • HCA-CNA Bridge Program

  • HCA-CNA Bridge Program - (Active WA HCA License Required)


    Tuition is $650 (plus tax), which includes a non-refundable $50 registration fee. There are no installment plans are available for this program.

    To Enroll Today: Full payment is due at registration.

     To verify if you have an active HCA license, visit the WA credential Search site at https://wahelms.my.site.com/s/license-search

  • Browse Files
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    Choose a file
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  • Choose your Start Date*

  • Admission Requirements

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

  • Final Step: Select Program and Make Payment.

  • Tuition Programs*

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    HCA-CNA Bridge Tuition (Full Payment). Full Payment for HCA-CNA Bridge Program (5 Days)
    HCA-CNA Bridge Tuition (Full Payment)

    Full Payment for HCA-CNA Bridge Program (5 Days)

    $650.00$650.00
      
    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.

  • 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.*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: