Nursing Assistant Training Program Enrollment Form

Nursing Assistant Training Program Enrollment Form
General Information
Name*

First NameLast Name
Address*

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Phone Number*
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Email*
example@example.com
Date of Birth mm/dd/yyyy*
Ethnicity*
Gender*
Social Security No.*
Prior Education*
2025 Desired Start Date*

May 12, 2025 4-Week Course DaysMay 19, 2025 4-Week Course Days

My Products*

CNA Training Program- Early Bird PricingMoore Allies Nursing Assistant 4 week Training Program.

$1,700.00

BLS Provider TrainingAHA Basic Life Support Training & Certification

$75.00

Fingerprint Clearance Card

$95.00

TB Screening

$80.00

Drug Screening

$55.00 Quantity

Enter coupon

Total

$0.00

Credit Card

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ACH Bank Transfer

Afterpay

Admission Requirements

Admission requirements for all prospective students of the Moore Allies Nursing Assistant Training Program include:
- Passing a criminal background check
- Completing a health and drug screening including a negative TB test
- Ability to speak, read, and write in the English language to comprehend course materials and perform duties safely
Three-Day Cancellation:

Applicants who provide a written cancellation notice within three days (excluding Saturday, Sunday and federal and state holidays) of signing an enrollment agreement are entitled to a 100% refund of all monies paid to Moore Allies Certified Nursing Assistant Training Program within 30 days of receipt the written cancellation notice.
I have read and understand the Admission Requirements and the Three-Day Cancellation policy for Moore Allies Nursing Assistant Training Program*
My signature below certifies that I have completed this form, that the information I have provided is true and accurate to the best of my ability and I wish to electronically.*

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General Information