CNA Student - NACTEP Application

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Please complete this application if you have enrolled in the NHSC CNA 8 Week Training Program.

Email *

Today's Date *

YYYY

Are you enrolled in the NHSC CNA Course? If no, do not complete this application. *

Yes

What date does this training start? *

YYYY

First Name *

Last Name *

Student ID #

Last 4 of Social *

Best E-mail Address *

Best Phone Number *

What is your mailing address? *

Are you enrolled in a Federally Recognized Tribe? *

Yes

Which of these apply to you? *

I am enrolled in a federally recognized tribe.

I am an individual from an economically disadvantaged family.

I was a child in foster care.

I am preparing for a non-traditional training field. i.e. female welder/male nurse.

I am out of work due to inadequate job skills or training.

I am a single parent (or pregnant woman).

I am an individual with a disability.

I am a displaced homemaker.

I am homeless.

I have other academic barriers such as: English as a second language, IEP or 504 in the past.

My FAFSA Family Contribution is Zero - for those who have completed a FAFSA.

I am or was a Youth who had a parent in the armed forces on active duty. May have required moving from place to place frequently.

Required

Household size? How many people live in your home? *

What is your annual/or (monthly) household income? *

In what city or town do you live? *

What is your Date of Birth? *

YYYY

Did you obtain a GED or a High School Diploma? *

GED

High School Diploma

Are you male or female? *

Male

Female

Are you currently employed? *

Yes

Seeking Employment

Will you use this training to become employed? *

Yes

Do you plan to continue your education after this training? *

Yes

Unsure

Do you plan to join the military? *

Yes

Important Notes

If you have any questions or concerns please contact the NACTEP Staff at nactep@nhsc.edu.

Disclaimer

Thank you for applying to the NACTEP Program. Please give use 5-10 business days to process your application. Thank you for your patience.

Tuition, Books and Fees Policy

As of Know the NACTEP Program will not be paying for your Tuition, Books and Fees until you successfully finish the semester.

Failure to complete semester will mean no tuition, book's and fee payments made on your student account.

A copy of your responses will be emailed to the address you provided.

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