EmailMeForm
Clackamas Nursing Assistant Training Application
First Name
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Last Name
*
Street Address 1
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Street Address 2
City
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State
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Zip Code
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Email
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Phone
*
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How do you prefer to be contacted
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Yes
No
I will respond to text messages
I will respond to Email messages
I will respond to voice or voicemail
Please select the class dates you wish to attend.
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Class #32 - Feb 27 through Apr 11, 2023
Class #33 - Apr 24 through Jun 8, 2023
Class #34 - Jun 26 through Aug 10, 2023
Class #35 - Aug 25 through Oct 12, 2023
Class #36 - Oct 30 through Dec 14, 2023
Please enter any questions or comments you may have:
You MUST answer the following questions:
*
Yes
No
I understand that completing this application does not guarantee me admission into the program.
I understand that I will be asked to submit to a drug screen.
I understand that I must submit to a criminal background check by a vendor that meets the requirements of the Oregon Health Authority.
I am able to speak, read, write, and understand the English language.
I understand that I must complete the Basic Life Support CPR course, which is not included in the tuition.
I understand that I must provide proof of at least two (2) doses of COVID-19 vaccine.
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