• CNA Student Registration Form

    Provide your details, credentials, and signature to secure your registration for the Certified Nursing Assistant programs.

  • Student Information

  • The Workforce Board (the state agency that regulates this school) requires that we ask you for this information, by law (RCW 28C.10.050). Providing your social security number is voluntary. By law, the information you provide on this form cannot be given out by any state agency as public information. The Workforce Board will not disclose data to anyone except authorized Workforce Board employees or contractors working on specific research activities, who follow strict confidentiality procedures. This format follows the information required to be submitted by the school as part of the annual student data report.

  • Format: (000) 000-0000.
  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Race*
  • Are you Hispanic in origin?*
  • Sex*
  • Are you Disabled?*
  • Are you a military veteran?*
  • Employment Status*

  • Student Information

  • Are you 18 years of age or older?*
  • Are you able to pass a criminal background check?*

  • CNA Traditional Program

  • CNA Program Tuition & Payment Options.

    Total tuition is $950 (plus tax), which includes a non-refundable $50 registration fee. All tuition payments are non-refundable upon cancellation.

    Pay in Full: Total balance is due today.
    Payment Plan: First installment is due today, the remaining balance is due in 14 days, and a $20 Installment fee applies.

  • Choose your Start Date*
  • Are you making a full payment or payment plan?

  • Admission Requirements

  • To enroll in the Nursing Assistant Certification (CNA) Program, students must meet the requirements and agree to provide required documents.

  • Final Step: Select Program and Make Payment.

  • Tuition Programs*

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    CNA/NAC Program Tuition (Full Payment). Full Payment for CNA Traditional Program (3 Weeks)
    CNA/NAC Program Tuition (Full Payment)

    Full Payment for CNA Traditional Program (3 Weeks)

    $950.00$950.00
      
    CNA/NAC Payment Plan - $900 Plus Tax plus $20 Installment Fee (Bi-Weekly). CNA/NAC Payment Plan - 3 Week program Bi-Weekly Plan - 2 Payments First Payment Due today - $500. The balance is due in two weeks
    CNA/NAC Payment Plan - $900 Plus Tax plus $20 Installment Fee (Bi-Weekly)

    CNA/NAC Payment Plan - 3 Week program Bi-Weekly Plan - 2 Payments

    First Payment Due today - $500. The balance is due in two weeks

    $500.00$500.00
      
    Subtotal
    $0.00$0.00
    Tax
    $0.00$0.00
    Total
    $0.00$0.00

    Payment Methods

    creditcard
    After submitting the form, you will be redirected to Apple Pay to complete the payment.
    After submitting the form, you will be redirected to Google Pay to complete the payment.

  • Electronic Signature Requirements

    By checking the boxes below, I certify that I have read & I do meet the requirements of the program and that the information provided is accurate and true to my knowledge.
  • Date of Signature - Must be on the same date you are completing this form.*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: