SRNA Application
The SRNA (formally a CNA) training will take place May 27-June 14, 2019. Interested students must complete the below application. Preference is given to pre-physician assistant students.

Do not apply for this course if:
* you can not pass a drug test.
* you owe money to KCTCS (the state checks to see if you owe money prior to allowing you to take the state exam).
* you are on the Nursing Assistant Abuse Registry.
* you are on the Caregivers Misconduct Registry.

Please note: If you have been convicted of a crime, please explain in your application. A criminal conviction does not immediately expel you from the program.

Questions: Contact Catherine Malin -- catherine.malin@wku.edu - 270-745-3325
To learn more: https://www.wku.edu/scahec/srna.php 
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Basic Applicant Information
Name: *
WKU 800# *
Phone Number: *
Preferred Email Address: *
Expected Graduation Date: *
Major or Areas of Concentration: *
GPA *
By the end of the Spring 2019 semester will you have completed at least 45 credit hours? *
Have you ever been convicted of a crime? *
If you answered yes to the above question, please explain.
Demographic Data
This program is supported by SC KY AHEC at WKU. Collection of the the following information is a requirement of this grant.
Gender *
Race (select all that apply)
Ethnicity:
Clear selection
Do you consider yourself from a rural area? *
Do you consider yourself from an undeserved area? *
SRNA Specific Questions
This course is intended to give you the skills needed to work as a State Registered Nurse Aide. Do you intend to seek employment as an SRNA? *
How will becoming an SRNA help you reach your health profession goals? *
Write a personal statement expressing your motivation or desire to become a medical professional (i.e. doctor, PA, etc.). Make sure you specify which medical professional you wish to become. (2,500 character max, spaces count as characters). *
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