CERTIFIED NURSE ASSISTANT - 2018-19
You are applying to the Adult Education Certified Nurse Assistant Program, this program is offered by the Sweetwater Union High School District. National City Adult (NCA) Program is in the evening for 9 weeks and the San Ysidro Adult (SYA) Program is in the morning for a full semester. Please make sure you select the program of your choice.
Choose the ONE Certified Nurse Assistant schedule that your interested in attending- *
1. Last Name *
Your answer
2. First Name *
Your answer
3. E-mail *
Your answer
4. Phone Number (s) *
Your answer
5. Address *
Your answer
6. City *
Your answer
7. Zip Code *
Your answer
8. Date of Birth *
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9. Student ID# (if enrolled in any SUHSD Adult schools)
Your answer
10. TABE Reading Assessment Score *
Your answer
11. Date of completed Healthcare Essentials *
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12. What school did you completed Healthcare Essentials *
13. Have you ever been convicted of a crime? If your answer is YES, please be advised that the Department of Public Health (CDPH) will not allow CNA certification with convictions. For more information contact the CDPH , Aide Certification Section. At 1615 Capitol Avenue, MS 3301, P.O. Box 997416, Sacramento, CA 95899-7416. Phone: 619-2445, or email: cna@dsph.ca.gov *
14. Do you have any health problems that require medication and / or limit your physical activity? If YES, please describe.
Your answer
15. Are you being sponsored by an agency? *
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