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Certification
Contact
Home
About
Certification
Contact
206-475-0928
Certified Nursing Assistant
(CNA) Program Application
Preferred Method of Contact
Phone
Email
Text Message
High School Diploma
GED
Some College
Associates Degree
Bachelor's Degree
Other
Program Applying For
Certified Nursing Assistant (CNA) Training Program
CNA Refresher Course
Other
Are you at least 18 years of age?
Yes
No
Do you have reliable transportation to attend classes and clinical training?
Yes
No
To participate in clinical training, students may be required to provide documentation of:
Tuberculosis (TB) Screening
Immunization Records
COVID-19 Vaccination (if required by clinical site)
CPR Certification (if applicable)
Physical Examination Clearance
Do you anticipate any limitations that may affect your participation in classroom or clinical activities?
No
Yes
Have you ever been convicted of a misdemeanor or felony that may affect your eligibility for clinical placement or state certification?
No
Yes
Personal Statement
I certify that all information provided in this application is true, accurate, and complete to the best of my knowledge. I understand that any false or misleading information may result in denial of admission or dismissal from the program. I understand that admission to PNW Nursing Assistant School is contingent upon meeting all enrollment requirements, including submission of required documentation and payment of applicable tuition and fees.
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Please submit the following with your application
Copy of Government-Issued Photo ID
High School Diploma or GED (if required)
Enrollment Agreement
Tuition Payment or Payment Plan Agreement
Health and Immunization Documentation
Background Check Authorization Form
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