McKallen Medical Training CNA Course Registration
Approved American Red Cross Nurse Aide Training Provider
Your Name:
*
First Name
Last Name
Email Address: (Gmail preferred)
*
Email
Date of Birth
*
-
Month
-
Day
Year
MM-DD-YYYY
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number:
*
-
Area Code
Phone Number
Emergency Contact
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Program Option:
*
CNA-Hybrid Option w/ Weekday Clinical
CNA
Program Option
*
Online Hybrid & Weekdays Clinicals
Online Hybrid & Weekend Clinicals
In person Weekend Only- Riverside, CA
* CNA Clinical Location (Please Choose One)
*
Ontario
Big Bear Community Hospital
Riverside
Loma Linda
Van Nuys
Northridge
Woodland Hills
Sacramento
Method of Tuition Payment:
*
Credit/Debt (1 Payment)
I am interested in AfterPay Tuition options (4 payments interest free)
I am interested in scholarship opportunities ( Ontario or Riverside)
Start Date
*
February 13, 2023
March 6, 2023
March 27, 2023
April 17, 2023
May 8, 2023
May 29, 2023
June 19, 2023
July 10, 2023
July 31, 2023
Uniform Style
*
Male
Female
Uniform Size- TOP
*
X-Small
Small
Medium
Large
X-Large
2X-Large
Uniform Size- PANTS
*
X-Small
Small
Medium
Large
X-Large
2X-Large
3X- Large
Do you have access to a computer, laptop, or Mobile phone to receive and complete assigned coursework?
*
Yes
No
Have you ever been convicted of a crime?
*
Yes
No
If so please describe:
You may be eligible for financial aid if you are between 16-24 years old and are experiencing one or more of the following:
*
You qualify as low income
You're receiving disability financial assistance
You are currently homeless
You did not complete high school
You are currently in foster care
You recently aged out of foster care
None of the above apply to me
How did you hear about McKallen Medical Training?
*
Facebook
Instagram
Indeed
Google
Referral
My Products
*
prev
next
( X )
Course Deposit
$
150.00
Three-Day Cancellation: An applicant who provides written notice of cancellation within three (3) business days, excluding weekends and holidays, of executing the enrollment agreement is entitled to a refund of all monies paid, excluding the $150 non-refundable registration fee.
Total
$
0.00
Credit Card
Submit File(s)
Should be Empty: