EmailMe Form - Clackamas Nursing Assistant Training Application

First Name *
Last Name *
Street Address *
City *
State *
Zip Code *
Email *
Phone *
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Is English your primary language?
If NO, what is your primary language?
How do you prefer to be contacted *

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I will respond to text messages

I will respond to Email messages

I will respond to voice or voicemail
Please enter any questions or comments you may have:

You MUST answer the following questions: *

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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 and a background check.
I am able to speak, read, write, and understand the English language.
I understand that, if selected for the class, I must attend every scheduled day. If I must miss a classroom/lab day due to an emergency, I will be required to make up the missed time at a rate of $30 per hour.
I understand that there is no make-up day for the clinical portion of the course.
I understand that I must complete the Basic Life Support CPR course, which is not included in the tuition.

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