DHEC Richmond CNA Course Registration Form

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The safety of our students and staff is our main priority. If we experience a spike in COVID cases, our contracted facilities may delay clinical rotations as a preventative measure to protect the well-being of their residents. We will notify students as soon as possible. Please keep in mind it's the decision of the facility and not DHEC. DHEC will delay clinicals if we feel it's unsafe for our staff and students. Please sign your name indicating you read and understand this message. * This field is required.

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ALL NURSE AIDE AND MEDICATION AIDE STUDENTS ARE REQUIRED TO BE FULLY VACCINATED (COVID-19) BEFORE THE CLASS START.(Per our clinical contracts) WE WILL CHECK THE VALIDITY OF ALL VACCINATION CARDS. Please sign your name indicating you read and understand this message.* This field is required.

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For clinicals, your hair must be a natural color—meaning it should be a color that a person could be born with. The only exception to this rule is gray hair. If you arrive at clinicals with any shade outside of the colors shown in the picture below, you will be sent home. No exceptions!

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All braided hairstyles must be kept neat. For clinicals, the length of the braids must not pass your back. Any hair passing the shoulders must be in a ponytail or bun See the picture below for acceptable length

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For clinicals, your fingernails must not be longer than those shown in the picture. Fingernail polish is allowed only in solid colors or as a French manicure—no designs are permitted.

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For clinicals, you are not allowed to have the following shoes. Additionally, no bright-colored sneakers are permitted. No shoes with holes allowed.

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For clinicals, your eyelashes must appear natural. If they do not meet this requirement, you will be asked to leave. The following eyelashes are NOT ACCEPTABLE:

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For clinicals, you are allowed to wear only one set of earrings in your ears. Only one stud nose ring is permitted; hoop nose rings are not allowed. Additionally, no visible septum piercings are permitted. Aside from the one stud nose ring, none of the other piercings shown in the picture below are allowed.

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ALL APPLICANTS MUST BE ABLE TO READ, WRITE, SPEAK, AND UNDERSTAND ENGLISH FLUENTLY. Do you read, write, speak and understand English fluently?* This field is required.

YESNO

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Student Name

First Name

Last Name

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STUDENT INFORMATION* This field is required.

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Student Personal E-mail* This field is required.*** PLEASE DO NOT USE WORK OR SCHOOL EMAIL ADDRESSES ** THESE EMAIL ADDRESSES ARE OFTEN BLOCKED BY FIREWALLS

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Please upload your government-issued photo ID (such as a driver's license, ID card, or passport)* This field is required.

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Due to a recent increase in false fraud claims, we now require you to submit a picture of yourself holding your government-issued photo ID (such as a driver's license, ID card, or passport) next to your face. We will not process your registration form if this requirement is not fulfilled* This field is required.

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Please upload your TB screening/PPD results if already completed. If you have not received the vaccination or TB screening, please be prepared to present it on the first day of skills practice. Click next if you do not have a card to upload at this time.

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Are you a former DHEC student?

YESNO

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Have you ever been convicted of threatening another person, assault, battery, or theft?* This field is required.If yes, PLEASE NOTE: You will be responsible for uploading this information to the board of nursing at the end of the course to receive approval to take your State Boards. Dominion Health Education Center (DHEC) does not have control over final decisions of the Virginia Board of Nursing.

YESNO

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Have you ever been charged with a misdemeanor?* This field is required.If yes, PLEASE NOTE: You will be responsible for uploading this information to the board of nursing at the end of the course to receive approval to take your State Boards. Dominion Health Education Center (DHEC) does not have control over final decisions of the Virginia Board of Nursing.

YESNO

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Have you ever been convicted of a felony?* This field is required.If yes, PLEASE NOTE: You will be responsible for uploading this information to the board of nursing at the end of the course to receive approval to take your State Boards. Dominion Health Education Center (DHEC) does not have control over final decisions of the Virginia Board of Nursing.

YESNO

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If you are a convicted felon OR if you have been charged with theft, threatening another person, assault or battery, you will have to submit supported documents as requested by the Virginia Board of Nursing, when you register for your state boards ** Please note: we complete a criminal and sex offender background check on all enrolled students**

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Emergency Information* This field is required.

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How did you hear about us?* This field is required.

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2026 Nurse Aide Schedule and Payment Plan

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In-Person Session Dates

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CNA students are required on-site on Tuesdays and Thursdays each week for skills sessions and/or clinicals. The skills lab will be completed in weeks 2, 7, and 8 at the school. Clinicals will be completed in weeks 3, 4, 5, 6, and 7 at the designated healthcare facility. The time for both in-person skills and clinicals is 3:30 pm - 9:30 pm. * This field is required.Please sign to acknowledge you have read and agree to the in-person schedule above.

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Please choose a class* This field is required.

1/5/26 – 2/27/26

3/9/26 – 5/1/26

5/11/26 – 7/10/26 No in-person sessions the week of June 1st

7/13/26 – 9/4/26

9/14/26 – 11/6/26

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CNA students are required on-site once a week for skills sessions and/or clinicals. Please select your preferred weekly skills lab/ clinicals day. The skills lab will be completed in weeks 2, 7, and 8 at the school. Clinicals will be completed in weeks 3, 4, 5, and 6 at the designated healthcare facility.* This field is required.Wednesdays or Thursdays only

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If you are registering for one of the medication aide courses, please upload a picture of your PCA , Nurse Aide , or CNA certificate. We will verify all certificates. If we are unable to verify your certificate, your enrollment will be cancelled.

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What/Who inspired you to become a CNA?* This field is required.

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Select Scrub Top Size -We provide our students with one white scrub top. Students are responsible for purchasing their own scrub pants CNA students wear navy scrub pants.. * This field is required.

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10- Panel Drug Test and Random Drug Test done(including marijuana) @ DHEC and /or clinical site discretion. If the applicant fails drug test he/she will be dropped from their course immediately. No Refund will be issued. Please initial* This field is required.

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Nurse Aide applicants must have PPD completed prior to clinicals. Please initial.* This field is required.

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Tattoos must be covered during clinicals. Some exceptions apply per instructor. Please initial* This field is required.

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Nails must be kept short(no more than 1/2 inch long)No bright colors. No embellishments. No chipped polish. Please initial* This field is required.

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Makeup and eyelashes must be natural looking. Eyelashes must be natural length. Please initial* This field is required.

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No facial piercings during clinicals. Only one stud nose ring allowed. Please initial* This field is required.

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For clinicals, your hair must be the color that you or another person could be born with (blacks, browns, blondes, brunettes, natural reds. Gray hair is acceptable, of course! Please initial * This field is required.

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When in uniform, no headbands, headscarves, or headwraps(unless for religious purposes), no caps or hats. Please initial.* This field is required.

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The school reserves the right to deny admission based on information obtained from the criminal background check. If admission is denied the applicant is entitled to a full refund. Please initial* This field is required.

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I First Name * Last Name * acknowledge the following drug policy: Drug Policy - DHEC reserves the right to conduct a 10-panel drug test at our discretion, which includes testing for marijuana. If you test positive for any drugs, including marijuana, you will be removed from the course and will not be eligible for a refund of any payments made. Please sign your full name: Signature *

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REFUND POLICY: I First Name * Last Name * acknowledge my $350 deposit/ $350 of my full tuition payment is nonrefundable. If I wish to change my enrollment to the next class, I must provide a written transfer notice (email accepted) at least seven business days before the start date of the class I am currently enrolled. Otherwise, the $350 deposit will be non-transferable.
Please sign your full name. Signature *

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I First Name * Last Name * acknowledge the following cancellation policy. Cancellation- To receive a refund of the tuition payments (this does not include the non-refundable $350 deposit), the applicant must provide the school with a written notice of cancellation (email accepted) at least seven business days(this does not include the weekend) before the start date of the class they are currently enrolled. Otherwise, the applicant will not be eligible for a refund of tuition payments. The school will allow the applicant to transfer to the next class in verified emergencies. Please sign your full name: Signature *

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I First Name * Last Name * acknowledge that if I am a no-call no-show on the first day of class or other scheduled days of class, I will be dropped from the class. No refunds will be issued, and I will be responsible for any unpaid balances. I must log in to the student portal on the first day of class. Please sign your full name: Signature *

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I First Name * Last Name * acknowledge the following tuition payment policy: Tuition Payment- If the tuition payments are not received before 5:00 pm on the due date, the student will be dropped from the class. If a student is dropped for nonpayment, no refunds will be issued, and the student is responsible for any unpaid balances. Please sign your full name: Signature *

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All payments ($350 deposit and any missed payments) are due at the time of registration. Please return to our website to look at payment deadline dates or call the school if you are unsure. We will not process your registration without full payment due. Please initial.* This field is required.

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Is someone else using their credit card to register the student for class? If so, please provide the credit card owner's First and Last Name, Address, and Phone Number. If not, please write N/A* This field is required.

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In an effort to protect against fraud, If cardholder is not the student, please upload cardholders drivers license.

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**Please Read and Sign** By signing this contract, you agree that all information provided is true, accurate, and complete. You also agree to the payment terms outlined in this contract. If you are dropped from this class due to failure to make the required payments by the due date, you will not be eligible for a refund of any tuition already paid. Additionally, you will still be responsible for any remaining balance. If you choose to withdraw after the start date, you will continue to be responsible for any remaining payments owed. Should you fail to pay the outstanding balance within 30 days, your account may be forwarded to collections. By signing this agreement, you acknowledge that you accept all terms, including the Electronic Payment Authorization and Recurring Charges Authorization (if you have elected to pay via recurring electronic funds transfers). You also confirm that you are the cardholder or have permission to use the credit/debit card that was provided during registration. PLEASE SIGN YOUR FULL NAME* This field is required.

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2026 CNA Schedule and payment plan

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If you are unsure of the amount that's due at your time of registration, please call the school at 804.340.6163. If you are registering after business hours, please email us at info@dominionhealthed.com to determine the amount due at info@dominionhealthed.com.

**If you email after 9 pm, we will respond the following day.**

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Select the tuition option and past due payment options. Please be sure to include any past-due payments. If you only submit the deposit and payments are due, your registration will not be processed until all payments due are received. We will not hold your registration. If you wish to make payments and not make full payments, please check that option. We will not issue a refund if you accidentally choose full payment instead of payment plan of deposit and missed payments. The full amount will be applied to tuition.* This field is required.You must make all payments on time to avoid being dropped from the class. If you do not make your payment by the due date , you will be dropped from the class. No exceptions. We will not grant extensions. If you wish to purchase the totes, tumblers, hoodies, or t-shirts below payment is due for these products at time of registration. They can also be purchased on our website..

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Nurse Aide (CNA) Full payment ($350 non-refundable)
$1,400.00Edit
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Nurse Aide(CNA) Course Deposit (non-refundable)
$350.00Edit
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Nurse Aide (CNA) class past due payments
$150.00Edit
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