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 #25 - Nov 4 through Dec 19, 2019
Class #26 - Jan 13 through Feb 26, 2020
Class #27 - Mar 9 through Apr 21, 2020
Class #28 - May 4 through Jun 16, 2020
Class #29 - Jul 6 through Aug 18, 2020
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 must complete the Healthcare Provider or Basic Life Support CPR course, which is not included in the tuition.
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