DHEC Personal Care Aide Course Registration Form

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Our online PCA class will include skills videos with a test-your-knowledge exercise segment. There are no on-site requirements. Please sign your name indicating you have read and understand this message. * This field is required.
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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* This field is required.
First Name
Middle Name
Last Name
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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
example@example.com
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Student Information
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Social Security Number* This field is required.Needed for background check
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Please upload a picture of your government-issued picture ID (driver's license 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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Gender* This field is required.
Male
Female
N/A
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Have you ever been convicted of threatening another person, assault, battery, or theft?* This field is required.This will not prevent you from taking the class but it may prevent employment with some establishments
YESNO
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Address* This field is required.
Street Address
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Have you ever been charged with a misdemeanor?* This field is required.This will not prevent you from taking the class but it may prevent employment with some establishments
YESNO
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Have you ever been convicted of a felony?* This field is required.This will not prevent you from taking the class but it may prevent employment with some establishments
YESNO
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Phone Number* This field is required.
Area Code
Phone Number
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Emergency Contact Name * This field is required.
First Name
Last Name
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Emergency Contact Phone Number* This field is required.
Area Code
Phone Number
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Emergency Contact's Relation to the Student* This field is required.
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How did you hear about us?* This field is required.
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2025 PCA Class Schedule
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Choose Class start date * This field is required.
Date
Year
Month
Day
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ONLINE MEDICATION AIDE STUDENTS ONLY : Students are required on campus the first week of class for skills practice. This practice will be on Thursday from 4:00pm - 8:00pm. Please initial to acknowledge you have read this. If this does not apply to you please write n/a. DUE TO COVID-19 THIS SCHEDULE WILL BE FLEXIBLE WHEN WE ARE ABLE TO SAFELY HOLD SKILLS LAB, WE WILL HAVE AN EVENING CLASS AND DAYTIME CLASS FOR SKILLS LAB.* This field is required.
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* This field is required.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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Why did you decide to become a Personal Care Aide?* 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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Please enter your initials to acknowledge that $200 of your payment is nonrefundable. If an applicant wishes to change their enrollment to the next class, the applicant must provide a written transfer notice (email accepted) at least 7 business days before the start date of the class they are currently enrolled. Otherwise, $200 will be non-transferable. Students are allowed one class transfer only. Please initial * This field is required.
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Cancellation- To receive a refund of tuition payments (this does not include the non-refundable $200 non-refundable deposit) the applicant must provide the school with a written notice of cancellation (email accepted) at least 7 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 initial* This field is required.
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No Call No Show - Applicants who are a no call no show on the first day of class or other scheduled days of class will be dropped from the class. No refunds will be issued and the applicant will be responsible for any unpaid balances. Please initial * This field is required.
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Tuition Payment- If tuition payments are not received on or before 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 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 credit card owners 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 agree to the payment terms of this contract. You agree if you are dropped from this class for not making your required payments, on the due date, you will not be eligible for a refund of any money paid towards the tuition. You will also be responsible for the remaining balance. If you choose to withdraw, after the start date, you will still be responsible for any remaining payments owed. If you do not pay the remaining balance within 30 days, your account will be forwarded to collections. You agree to all terms of this Agreement, including, but not limited to, the Electronic Payment Authorization, Recurring charges authorization(if you have elected to pay by recurring electronic funds transfers), when you sign this Agreement. By signing this agreement, you acknowledge you are the cardholder or have permission to use the credit/debit card used at time of registration PLEASE SIGN YOUR FULL NAME* This field is required.
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Select tuition option and past due payment options. Please be sure to include any past due payments. If you only submit the deposit, your registration will not be processed until all payments due are received. We will not hold your registration. PLEASE SCROLL THROUGH THE COURSES BELOW TO FIND THE COURSE YOUR DESIRED COURSE* 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.
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PCA Course Full Payment ($200 of the $425.00 is non-refundable)
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