CNA/CLS Program Interest

Your Name:

First NameLast Name

Birth Date:

Email:

example@example.com

Phone Number:

Please enter a valid phone number.Format: 000-000-0000.

Program of Interest:

Semester Applying For:

Which program do you plan to enroll in after taking this course?

Other

Do you live in Nevada?

Do you intend on seeking employment in Nevada upon completion of your program?

Information Night:

Certification and Acknowledgment

By pressing submit, I understand that this degree/certificate leads to professional licensure in Nevada. Licensing requirements vary by state and territory, and relocating may impact my eligibility for licensure. If I do not reside in Nevada and/or do not plan to seek employment in Nevada, my application will be reviewed to determine eligibility for licensure in my state before acceptance into the program.

Please verify that you are human:

Sender Name: