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This Clinical Medical Assistant Registration has Closed. Check back for Fall Registration in July.
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Name
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Address
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Phone Number
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Email Address
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Date of Birth
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Do you have a high school diploma or GED
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Are you currently enrolled in the Come Back Kids Program or did you receive your high school diploma from the Come Back Kids Program?
Yes
No
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Are you currently enrolled in Project YES?
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No
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Do you receive CalFresh, CalWORKs or cash aid? *
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Are you a citizen of the United States?
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Yes
No
Do you speak any other languages besides English?
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Your answer
Do you foresee any circumstances that may interfere with your ability to complete the course?
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Your answer
Please note that this course will require a drug test in order to work in the hospitals or doctor’s offices
I understand that I will be required to pass a drug test in order to be approved for this program
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I certify that my answers are true and complete to the best of my knowledge. If this application leads to enrollment, then I understand that false or misleading information in my application or interview may result in my release from the program.
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