New Med-Cert Online Applicaton

Med-Cert Online Applicaton - STNA (AKRON)

Application for Admission Nurse Aide Training Program

Program

Enroll In

Campus

Applicant Information

First Name

Middle Name

Last Name

Street

City

State/Province

Zip/Postcode

Home Phone

Cell Phone

Birth Date

Social Security Number

Gender

High School Diploma/GED

Yes No Not Selected

In Case of Emergency

Contact Name

Relationship

Home Phone

Accommodations

At Med-Cert Training Center, we want every student to be successful. Do you have any learning needs, accommodations, or support services you would like us to be aware of to help you succeed?

Learning Needs

Yes No Not Selected

Learning Needs Description

Required Documentation

Students will need to submit a TB test, Physical, Criminal Background Check, proof of Vaccination or a religious/medical waiver against vaccination.

Refund Policy

AKRON CLASSES ARE NON-REFUNDABLE. There are no refunds.

Signature

Your signature below indicates that all information entered is correct and that you have read and agreed to abide by our Refund Policy (AKRON CLASSES ARE NON-REFUNDABLE).

Student Signature

Date

Select a Payment Plan below to continue your applicaton. AKRON STNA class tuition is currently $540. Please select your appropriate payment plan below.

Payment Plan

Default Payment Plan for Invoice

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