Hero Training Center

HERO TRAINING CENTER

Nurse Aide (CNA) Program Enrollment Application

First name*

Last name*

Email*

Phone

Preferred Class Schedule *

Day Class

Evening Class

Next Available class

Payment Option*

Pay Tuition in Full

Payment Plan

Third Party Financing

Other

Please list any questions or special accomodations you would like to discuss

Address*

Birthday*

Month

Day

Year

Enrollment Elgibility

Are you at least 16 years of age?*

Yes

Do you have a high school diploma or GED?*

Yes

Currently Enrolled

Do you understand that clinical attendance is required?*

Yes

Are you able to read, write, speak, and understand English sufficiently to participate in the program?*

Yes

Clinical Requirements

I understand that the required health/clinical documentation must be submitted before attending clinical.

I understand that a background check may be required

I understand that I must follow Hero Training Center's dress code and clinical policies.

Payment Acknowledgement

I understand that tuition and applicable fees must be paid according to my enrollment/payment agreement

I understand that application/registration/down payment and administrative fees are non-refundable.

I understand that I will not receive my program completion letter or records until my account is paid in full.

Emergency Contact Name *

Emergency Phone Number*

Relationship to Student*

I certify that the information provided in this enrollment application is true and complete. I acknowledge that I have reviewed and understand Hero Training Center's enrollment requirements, clinical requirements, attendance expectations, and payment policies.

Signature*

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Date Signed*

Hero Training Center

810-820-8444

admissions@herotrainingburton.org

1069 East Bristol Rd.

Burton, Mi. 48529

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