2019-20 FALL SEMESTER CERTIFIED NURSE ASSISTANT PROGRAM
Thank you for your interest in our Certified Nurse Assistant Program. To complete this CNA program successfully, you must attend classes for 9 weeks at National City Adult School (Theory) and Fredericka Manor (Clinical). Our evening classes are Monday thru Friday, 4:00 pm to 8:00 pm.
Check the CNA schedule below *
Required
LAST NAME *
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FIRST NAME *
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E-MAIL *
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(AREA) PHONE NUMBER *
Your answer
ADDRESS (Street name and number) *
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CITY *
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ZIP CODE *
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DATE OF BIRTH *
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YYYY
STUDENT ID
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DATE OF COMPLETED HEALTHCARE ESSENTIALS *
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DD
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YYYY
WHERE DID YOU COMPLETED HEALTHCARE ESSENTIALS *
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HAVE YOU EVER BEEN CONVICTED OF A CRIME? IF YOUR ANSWER IS YES, Please be advised that the California Department of Public Health (CDPH) will not allow CNA certification with convictions. For more information contact: Department of Health Services, Division of Licensing and Certification, Nurse Assistant Certification Section. (916) 327-2445 *
DO YOU HAVE ANY HEALTH PROBLEMS THAT REQUIRE MEDICATION AND/OR LIMIT YOUR PHYSICAL ACTIVITY? IF YES, PLEASE EXPLAIN.
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ARE YOU BEING SPONSORED BY AN AGENCY? (If YES, choose agency) *
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