NCI Admission Application

Admission Application

Application is not complete until registration fee is paid.
Prospective students must be 18 years or older before graduation or completion of the program and must show proof of the following:
- Submit a completed admission application and enrollment agreement.
- High School, GED or College Transcript (showing High School completion)
- Registration fee (Refundable before the first day of class)
- Government issued ID with picture and signature
- One of the following: Social Security Card, Employment Authorization Document (DACA) or Birth Certificate
- Criminal Background (completed by Nursing Careers Institute)
- Physical Examination (provide copy of last exam; must be within a year)
- TB skin test (mandatory prior to clinical rotation)
- Verification of any immunizations; Hepatitis B is required or a declination form is acceptable.
What program?
Name

First NameLast Name
Address
City
State
Zip
DOB
Home Phone #
Cell
Email Address
example@example.com
Start Date

MonthDayYear
List the class date you would like to attend.
End Date

MonthDayYear
Date
HIGH SCHOOL NAME
START DATE
END DATE

MonthDayYear
Date
If you are registering for the December 1st-19th, 2025 Class, please select a time for the skills lab. You will be notified if your desired time has been accepted. It is on a first come first serve basis. (Note: If enrollment is 10 students or less, the default time will be 5pm-9:30pm)
Are you still in high school?*
List your current grade. Note: High School students are required to take a basic skills test. Once accepted into the program, a link will be provided to you to complete the test.
Are you a high school graduate? (Transcript required after acceptance)*
Diploma or GED*
Other Education
Other Certifications
Uniform Size

TERMS AND UNDERSTANDING
Fees and Charges:
- $75.00 Registration Fee
- $625.00 Tuition (Nurse Aide I)
- $300.00 Tuition (Medication Aide)
- $50 CPR (Provided during skills week if needed)
Other out of pocket fees: TB Test (Can be done at primary care physician or local pharmacy clinic).
I understand that:
1. The school does not guarantee employment following graduation. There will be job opportunities available, but you must qualify for them based on the job requirements.
2. The school reserves the right to terminate a student's training for failure to abide by the Attendance Policy, failure to maintain satisfactory academic progress, failure to abide by the school rules and regulations and for other reasons as detailed by the school catalog.
3. All fees are to be paid prior to the last day or the school reserves the right to withhold approval of taking the final exam.
4. Materials used in the classroom, lab and in the process of learning is the property of NCI and should not be removed from the school.
5. The school does not guarantee the transfer of credit to any other institution.
6. Any notification of withdrawal or cancellation must be in writing.
7. This agreement is legally binding when signed and accepted by the school. Your signature on this agreement acknowledges that you have been given reasonable time to read and understand it and that you have been given the program of instruction which are likely to affect your decision to enroll.
Student Rights to Cancel: You may cancel your enrollment agreement for the program at any time up to the first day of class. If you cancel this agreement any payment you have made will be refunded to you within 30 days. To cancel the enrollment agreement, you must email the administrator at the official email address.

Acknowledgement: Do not sign if you have not read this agreement in its entirety or if it contains blank spaces. You are entitled to an exact copy of the contract you sign. Keep it to protect your legal rights.

My signature certifies that I have read, understood, and agreed to my rights and responsibilities, that the institution's cancellation and refund policies have been clearly explained to me and that I have a copy of this agreement. I hereby accept this agreement with Nursing Careers Institute, Inc.
Student Signature

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Date

MonthDayYear
Date

Student Interview Form for

NC Nurse Aide I Program
Complete all questions:
1. What do you think it takes to be a good Nurse Aide?
2. What are three 3 words your friends would use to describe you?
3. Give an example of a time when you had to learn something new i.e. a task or procedure. How did you learn the new task or procedure?
4. Describe your best learning experience. What made the experience a good one?
5. Where do you see yourself in 3-5 years?

Emergency Notification Information
Emergency Contact #1
Relationship to the Applicant
Contact
Emergency Contact #2
Relationship to the Applicant
Contact
Hospital Preference
Primary Care Physician
Known Allergies
Previous Medical Conditions
*This information is for information purposes ONLY in case of an emergency. This information will not be used to determine admittance of an applicant.

Fee:

Registration FeeRegistration fee is 100% refundable before the first day of the program.

$75.00

Total

$0.00

Credit Card

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