If you want to apply for financial assistance, please fill out this form.
Your information will be forwarded to Catholic Charities of Northeast Kansas.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
County of Residence
*
Which Course Do You Want To Take?
*
Please Select
Nurse Aide
Medication Aide
Anything You Want Us To Know?
Terms
*
I agree to let Catholic Charities of Northeast Kansas contact me by phone and/or email regarding this application.
Submit
Should be Empty: