New Student Application for Enrollment Residential & In-Home Care Training
New Student Application for Enrollment - Residential & In-Home Care Training in Union City, CA
Email address
Which training to you want to attend
Today's Date
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Your Information
NHAS Student # (if you know it)
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First Name
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Middle Name
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Last Name
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Street Address
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Apt #
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City
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State (2 letter state code only)
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Date of Birth
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Home Phone
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Cell Phone
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Email Address
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Primary Language(s) spoken
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Are you a current student at a local adult school or community college?
If you answered YES, which one(s)
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What class(es) have you taken at Adult School or Community College in Alameda County in the last 12 months?
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Why are you interested in taking the Residential & In-Home Care Training Course?
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Do are you legally able to work in the United States? Proof of eligibility is required for the FEE WAIVER only
Would you like to request a FEE WAIVER?
Upon completion of this training are you interested in working part-time, full-time or both?
Required
Upon completion of this training what hours of the day would you like to work?
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Upon completion of this training what days of the week would you like to work?
Upon completion of this training what type of client(s) would you like to give care to?
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What are your work goals for the future? Where would you like to be in the next five years?
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Do have other information you'd like us to know?
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