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Certified Nursing Assistant

Make a career out of making a difference! Become a Certified Nursing Assistant!

Train for this rewarding healthcare career in just six weeks!

Program Overview:

Our Nursing Assistant program prepares students to become Certified Nursing Assistants (CNAs).

The curriculum covers safety, anatomy, nutrition, infection control, patient care, proper lifting techniques, and helping patients with rehabilitation.

Graduates of the program are ready to provide quality care and pursue certification.

CNA Program Pre-Requisites:

Proof of age (18 years or older)
High School Diploma/GED
Recent physical exam (within 90 days of class start)
Live scan fingerprints
TB test results
Flu shot
Covid vaccine
Hepatitis B Series proof

The program runs from January 6, 2025 – February 14, 2025.

Questions? Contact us at (831) 796-3335.

The program begins on Monday, January 6, 2025. There are only 15 available slots for this program, so apply today!

YOUNG ADULT PROGRAMS

Green Cadre

Health Cadre

Impact Cadre

Information Technology Cadre

Summer Cadre

CNA Training Program Application (Jan 2025)

Today’s Date
MM slash DD slash YYYY
Last 4 Digits of Your Social Security #*
Please enter a number from 0000 to 9999.
CONTACT INFORMATION
Name*
First Middle Initial Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Phone Type
May we send you text messages?
- Yes
- No
Email*
DEMOGRAPHIC INFORMATION
Date of Birth*
MM slash DD slash YYYY
Gender*
Selective Service (MALES ONLY)
Military Status*
If you are a Veteran you will be required to complete a WIOA Veteran Form at enrollment
Disability*
If “Yes”, you will be required to complete a WIOA Disability Form at enrollment
Authorized to Work in U.S.*
If U.S. Permanent Resident or Alien/Refugee:
Alien/Visa Registration #
Expiration Date
MM slash DD slash YYYY
Hispanic Heritage*
Race*
EMPLOYMENT INFORMATION
Employment Status*
If Employed, are you underemployed?
Registered Apprenticeship Program
Unemployment Insurance Eligibility
Number of Weeks Unemployed
Current/Previous Hourly Rate
Occupation
DISLOCATED WORKER ELIGIBILITY
Layoff Date
MM slash DD slash YYYY
Employer Name
Employer Address
Street Address Address Line 2 City State ZIP Code
Dislocation Hourly Rate
EDUCATION INFORMATION
Currently enrolled in school*
Highest Education Level*
High School Diploma or Equivalent Received*
PUBLIC ASSISTANCE
Temporary Assistance for Needy Families (TANF) – Recipient*
Supplemental Security Income (SSI) - Recipient*
General Assistance (GA)*
Supplemental Nutrition Assistance Program (SNAP)*
Refugee Case Assistance (RCA)*
Social Security Disability Insurance Income (SSDI)*
Receiving services under SNAP Employment & Training Program*
Receiving, or has been notified will receive, Pell Grant*
Ticket to Work Holder Issued by the Social Security Administration*
Foster Child (state or local payments are made for applicant)*
Youth currently living in high-poverty area*
Youth currently receives, or is eligible to receive free or reduced lunch under the Richard B. Russell National School Lunch Act*
BARRIERS
English Language Learner*
Basic Skills Deficient/Low Levels of Literacy*
Homeless*
Ex-Offender – individual has been arrested/convicted of a crime*
Displaced Homemaker*
Within 2 years of exhausting TANF lifetime eligibility*
Hawaiian Native*
American Indian/Alaskan Native*
Single Parent (including single pregnant women)*
Cultural Barriers*
FAMILY INCOME
Family Size*
Past 6 months Family Income*
APPLICANT CERTIFICATION STATEMENT
I certify that the information on this application is accurate to the best of my knowledge. I understand that my willful misstatement of the facts may cause my forfeiture of rights in the WIOA Program and may result in criminal action. I give permission for outside sources to be contacted and for them to disclose any information necessary to verify my eligibility for WIOA. I further understand and agree that my social security number and other information on this application will be provided to other government agencies as required by law.
Signature*
Date*
MM slash DD slash YYYY

Certified Nursing Assistant

Make a career out of making a difference! Become a Certified Nursing Assistant!

CNA Training Program Application (Jan 2025)

CONTACT INFORMATION

DEMOGRAPHIC INFORMATION

EMPLOYMENT INFORMATION

DISLOCATED WORKER ELIGIBILITY

EDUCATION INFORMATION

PUBLIC ASSISTANCE

BARRIERS

FAMILY INCOME

APPLICANT CERTIFICATION STATEMENT

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