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CNEI CNA Application Form

160 Hour Certified Nurses Assistant Certification Course

The 160 Hour CNA Class Consists of Everything you will need tfro the state exam and to complete the program. 60 Hours of theory study at CNEI. 100 Hours of clinical experience at CNEI clinical sites. You will be provided with tow uniforms, one gate belt, one stethoscope and one blood prissure cuff. Your are provided a certificatg of completion upon suscessful completion of the training program. State exam for theory and clinical is conducted at the school.

In order to attend classes, you must be able to supply the following:

1) Two forms of identification (Drivers's license and social security card)
2) High school diploma or GED.
3) Your payment of $2801.50, cash, check, credit card (Visa aor MasterCard)

A non-refundable deposit of $100.00 is necessary in order to hold a seat for the class.

Social Security Number (SSN) ___________ _______ ___________ ( will be add manually at the school) Do NOT instert her.

Name(Required)
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Address(Required)

Citizenship

Universities that are recipients of federal dollars are required by the Federal government to solicit certain demographic information to meet federal reporting requirements. Applications are requested to provide the following information voluntarily. This information will not be utilized in a discriminatory manner.

Citizenship Status

Demographics

EMERGENCY CONTACT

In the event there is an emergency on your behalf and we need to contact someone for you, please provide 2 contacts

Emergency Contact #1(Required)
Address
Emergency Contact #2(Required)
Address

Military

High School Information

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High School Address

College Information

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Questions

Background

If your records have been expunged pursuant to applicable law, you are not required to answer yes to the following questions. If you are unsure whether to answer yes, we strongly suggest that you answer yes and fully disclose all incidents to avoid any risk of disciplinary action or revocation of your offer of admission.

Accepted file types: pdf, doc, docx, jpeg, Max. file size: 10 MB.

Agreement

I understand that this application is for admission only for the term indicated. I agree that I am bound by the School's regulations concerning application deadlines and admission requirements. I agree to the release of any transcripts and test scores to this institution, including any SAT, Achievement Test, and ACT score reports. I certify that this information is complete and accurate. I understand that making false or fraudulent statements within this application or residency statement will result in disciplinary action, denial of admission and invalidation of credit or degrees earned. If admitted, I agree to abide by the policies of the School. Should any information change prior to my entry into the University, I will notify the Office of Admissions. I understand that the application fee I submit with this application is a non-refundable fee.

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Bureau for Private Postsecondary Education

BPPE P.O.Box 980818
West Sacramento, CA 95798
(888) 370-7589
www.bppe.ca.gov

Council on Occupational Education

COUNCIL ON OCCUPATIONAL
EDUCATION (COE)
7840 Roswell Road,
Bldg. 300, Suite 325
Atlanta, GA 30350
(800) 917-2081
www.council.org

Board of Licensed Vocational Nurses & Psychiatric Technicians

BOARD OF LICENSED VOCATIONAL NURSES & PSYCHIATRIC TECHNICIANS 2535 Capitol Oaks Drive, Suite 205
Sacramento, CA 95833
(916) 263-7800
www.bvnpt.ca.gov

US Department Of Veterans Affairs

US Department Of
Veterans Affairs
810 Vermont Ave., MN
Washington, DC 20420
(844) 698-2311
www.va.gov