Admission & Clinical Clearance Document Upload
Upload the individual enrollment and clearance documents you currently have. You may return to this same form to submit missing documents using the same name, email, program and class start date. Review the catalog and your program’s Performance Fact Sheet before signing the enrollment agreement. Submission does not itself grant clearance.
Student Information
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Program/Cohort
*
Please Select
CNA — Full-Time
CNA — Part-Time AM
CNA — Part-Time PM
CNA — Weekend
HHA — 40-Hour
HHA — 120-Hour
CPR/BLS
CEU
Class Start Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Document Uploads
Government-Issued Photo ID
Upload a File
Drag and drop files here
Choose a file
Upload a clear PDF, JPG, or PNG. Make sure the entire document is visible and readable.
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of
Student Headshot Photo
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Upload a clear PDF, JPG, or PNG. Make sure the entire document is visible and readable.
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Physical Examination / Health Clearance
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Upload a clear PDF, JPG, or PNG. Make sure the entire document is visible and readable.
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of
TB Clearance / TB Test Documentation
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Upload a clear PDF, JPG, or PNG. Make sure the entire document is visible and readable.
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of
COVID-19 Documentation if required by the assigned clinical site
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Upload a clear PDF, JPG, or PNG. Make sure the entire document is visible and readable.
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of
Live Scan / BCIA 8016 Documentation
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Upload a clear PDF, JPG, or PNG. Make sure the entire document is visible and readable.
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CDPH 283B Nurse Assistant Certification Training Program Application
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Upload a clear PDF, JPG, or PNG. Make sure the entire document is visible and readable.
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Additional Requested Document
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Upload a clear PDF, JPG, or PNG. Make sure the entire document is visible and readable.
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of
CDPH 283D — Home Health Aide Application
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Upload a clear PDF, JPG, or PNG. Make sure the entire document is visible and readable.
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Signed Enrollment Agreement
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Upload the completed signed enrollment agreement.
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School Catalog Acknowledgment
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Upload the completed document.
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Signed School Performance Fact Sheet — CNA or HHA
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Upload the completed document.
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Student Policy Acknowledgment
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Upload the completed document.
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Student and Emergency Contact Form
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Upload the completed document.
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Optional Media Release
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Upload the completed document.
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Required Acknowledgements
I certify that the information and documents I am submitting are accurate and belong to me.
*
I certify as stated
I understand that unreadable, incomplete, expired, or incorrect documents may delay my clearance and I may be asked to resubmit them.
*
I understand
Enrollment ID
Enrollment Verification
I understand that submission of documents does not itself mean I am cleared to start class or clinical training; Bell Healthcare Training School will complete a final review and issue a separate Clear-to-Start confirmation.
*
I understand
Securely Submit Documents
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