UCC Youth WIOA Training: CNA Program
Thank you for your interest with United Cambodian Community's Training Program for Certified Nursing Assistant (CNA). We are now beginning enrollment for 2024. Please select the times you are available to meet to discuss suitability and next steps to enrollment into UCC's Training Program for CNA.

Meeting will take place at United Cambodian Community at 2201 E. Anaheim St. Suite 200, Long Beach, CA 90804. Please email emily.wasilewski@ucclb.org with any further questions.
Sign in to Google to save your progress. Learn more
Email *
Full Name *
Best Contact Number *
The program is currently for Long Beach or Signal Hill residents only. Which city do you reside in? *
The program is currently for youths ages 17-24 years old. How old are you? *
What dates are you available to come in to do the eligibility paperwork and CASAS exam? *
Required
What is the best way to contact you? *
Required
Birthdate *
Home address (full address including zip code) *
How did you find out about our program? *
Are you a high school graduate? *
Why are you interested in the CNA program? 
 *
Are you currently in school? *
Are you currently working? *
Are you a parent or expectant parent? *
Required
Are you homeless? *
What are some workshop topics you would like to learn more about? (Ex. Resume, Interviews, How to Apply for Jobs) Please share any workshop ideas you'd like to learn more about!
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of United Cambodian Community.

Does this form look suspicious? Report

Google Forms