STNA Training Questionnaire
Personal Information:
Full Name
*
First Name
Middle Name (Optional)
Last Name
Age
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
How did you hear about us?
Please Select
facebook
instagram
tiktok
google
word of mouth
Sex
*
Please Select
Male
Female
E-mail
*
example@example.com
Questions and Details:
Are you a current Cuyahoga or Lake County resident?
Please Select
Yes, Cuyahoga
Yes, Lake
No, neither
Do you currently receive government resources, like SNAP, TANF, medical, or other income eligible benefits?
Please Select
Yes
No
Are you interested in taking a FREE STNA Training course that could jumpstart your career within 3 weeks (3 days/week) with a job immediately upon completion?
Please Select
Yes
No
By signing here, I acknowledge all information given before and during each session is completely confidential, and that all information provided in this document is true to the best of my knowledge.
*
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Submit
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