McKallen Medical Training CNA Class Registration Form

McKallen Medical Training CNA Course Registration

Approved American Red Cross Nurse Aide Training Provider
Your Name:*

First NameLast Name
Email Address: (Gmail preferred)*
Email
Date of Birth*

MonthDayYear
MM-DD-YYYY
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:*

Area CodePhone Number
Emergency Contact*

First NameLast Name
Phone Number*

Area CodePhone Number
Program Option:*
Program Option*

Online Hybrid & Weekdays ClinicalsOnline Hybrid & Weekend ClinicalsIn person Weekend Only- Riverside, CA
* CNA Clinical Location (Please Choose One)*

OntarioBig Bear Community HospitalRiversideLoma LindaVan NuysNorthridgeWoodland HillsSacramento
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*
Uniform Style*
Uniform Size- TOP*

X-SmallSmallMediumLargeX-Large2X-Large
Uniform Size- PANTS*

X-SmallSmallMediumLargeX-Large2X-Large3X- Large
Do you have access to a computer, laptop, or Mobile phone to receive and complete assigned coursework?*

YesNo
Have you ever been convicted of a crime?*

YesNo
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 incomeYou're receiving disability financial assistanceYou are currently homelessYou did not complete high schoolYou are currently in foster careYou recently aged out of foster careNone of the above apply to me
How did you hear about McKallen Medical Training?*

My Products*

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

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McKallen Medical Training CNA Course Registration

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