CNA Information Form
Please fill out the following information and one of our training program coordinators will contact you within the next 72 hours.
This program is only for Dane County, Wisconsin Residents.
*Answering all questions is required.
How did you find out about the program?
La Movida, Radio
Word of Mouth
Family or friend referral
Referred by another organization
What is your age?
Which city do you live in?
Which county do you live in?
What's your race/ethnicity?
American Indian and Alaskan Native (Cherokee, Chippewa, Navajo, Sioux)
Asian (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Hmong, Other Asians)
Native Hawaiian and Other Pacific Islander (Guamanian, Chamarrow, Saamoan)
Two or more Races
Hispanic/Latino (Mexican, Puerto Rican, Cuban and other Hispanic or Latino)
White, Not Hispanic or Latino
From the following list, please check the items that apply to you:
1- Completed High School or GED/HSED Diploma
2- Completed High School in the country of origin (must have access to original documents)
3- I am 18 years or older
4- Authorized to legally work in the United States
5- English Language Learner at an Intermediate or Advanced Level
If you’re a male between the ages of 18 and 25, have you registered for SelectiveService?
Please indicate your English level:
Have you taken the Accuplacer (Reading 60+) test within the last 2 years, or Accuplacer New-Generation (Reading 240+) test this year at Madison College?
Please attach your most recent Accuplacer Test results during the last two years in PDF format (If applicable).
If you recently graduated from High School, did you take the ACT test (Reading 13+)?
If you’re looking for a training in a differentfield, please specify:
Should be Empty: