EmailMeForm
Clackamas Nursing Assistant Training Application
First Name
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Last Name
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Street Address
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City
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State
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Zip Code
*
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 #39 - May 1 through May 31, 2024
Class #40 - Jun 17 through Jul 18, 2024
Class #41 - Jul 29 through Aug 27, 2024
Class #42 - Oct 7 through Nov 6, 2024
Class #43 - Nov 18 through Dec 19, 2024
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.
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.
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