Christian Science Nursing Assistant Class
High Ridge House
August 18-22, 2025
Name
*
First Name
Last Name
Phone Number
*
Email
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you a member of The Mother Church
Yes
No
Are you a member of a Branch Church?
Yes
No
Name of CS Branch Church/Society/College Org
Will you be needing financial assistance?
Yes
No
Will you be needing housing?
Yes
No
Tell us a little about yourself. Past employment and church activities
Please let us know why you are interested in taking the CSNA class
References
Please list two (2) references .
Reference
Reference
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