CNA Readiness Questionare

Form
CNA Readiness Questionnaire

This questionnaire helps us understand your needs so we can recommend the best level of one-on-one support.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
When did you complete your CNA training?*

Within the lase 3 months3-6 months ago6-12 months agoOver a year ago
Have you taken the CNA Skills exam before?*

YesNo
If yes, how many times have you taken the exam?

OnceTwiceMore than twice
Have you taken the CNA Knowledge Exam before?*

YesNo
If yes, how many times have you taken the exam?

OnceTwiceMore than twice
For the Knowledge exam, which topics do you feel you need the most help with or if exam taken, which areas received the lowest scores?

SafetyInfection ControlResidents RightsBasic Nursing SkillsCare ImpairedData CollectionDisease ProcessMental HealthPersonal CareRoles and ResponsibilitiesCommunicationAge Process and Restorative CareDeath and Dying
Which do you feel you need the most help with?*

KnowledgeSkillsTest AnxietyI'm not sure
How confident do you currently feel about taking the CNA exam?*

Very confidentSomewhat confidentNot very confidentExtremely nervous or overwhelmed
What do you feel you need the MOST help with right now?*

Reviewing CNA knowledgeSkills practiceUnderstanding exam expectationsTest-taking strategiesBuilding confidenceCreating a study plan
When are you hoping to take (or retake) the CNA exam?*

Within the next 2 weeksWithin 1 month1-2 monthsNot sure
What is your main goal for joining the CNA Readiness Program?
Preferred session format*

In-personVirtualEither
How soon would you like to start the program?*

One WeekTwo WeeksThree WeeksNot Sure
Best availability for one-on-one sessions*

WeekdaysEveningsWeekendsMixture
What is your learning style?

Visual LearnerAuditory LearnerKinesthetic Learner (Hands-on)Reading/Writing Learner
Is there anything else you would like us to know about your situation or concerns?
Should be Empty:

Form

CNA Readiness Questionnaire