CERTIFIED NURSING ASSISTANT PROGRAM. January 2019 CNA Class

Transcription

1 Urbana Adult Education Center CERTIFIED NURSING ASSISTANT PROGRAM Student Application January 2019 CNA Class Begins: January 29 th, 2019 Graduates: March 28 th, 2019 Class applications due on: December 3 rd & 4 th, 2018 WIOA Applications due by: November 26 th, N. Race St. Urbana, IL Phone: (217) Fax: (217)

2 Please read this ENTIRE packet and follow all directions carefully! Table of Contents CNA FAQs... Page 3 Parking Instructions. Page 4 Eligibility Requirements, Criteria for Selection... Page 5 Health Care Worker Conviction Waiver Information.Pages 6-7 CNA Program Application Process, Required Documents... Page 8 Immunizations, Important Dates... Page 9 Non-Refundable Class Fees, Drug Screening... Page 10 CNA Course Information... Page 11 Mandatory Class Hours, Restriction on Vocational Hours... Page 12 Application for CNA Class.....Pages WIOA Scholarship & Hardship Fee Waiver Information.Page 16 WIOA Scholarship Program Information & Application... Pages Hardship Fee Waiver Guidelines & Application... Pages All information is subject to change. Urbana Adult Education will post any CNA updates or date changes on our Facebook and Twitter pages. We recommend following these to stay up-to-date.

3 CNA FAQs What does a CNA do? A certified nursing assistant, or CNA, helps patients or clients with healthcare needs under the supervision of a Registered Nurse (RN) or a Licensed Practical Nurse (LPN) Where do CNAs work? CNAs can work in a variety of health care settings, including nursing facilities, hospitals, residential care facilities, and home health care services. What is the job growth outlook? Overall employment of CNAs is projected to grow by 11% through 2026, much faster than the average job growth. As the baby-boom population ages, there is an increasingly high demand for CNAs to assist and care for elderly patients. (bls.gov) How much do CNAs make? In 2017, the average salary for a CNA in Illinois was about $27,000 per year. Wages can depend on what type of facility you work in, your experience level, the number of hours you work, and several other factors. Experienced CNAs in some areas can earn over $38,000 a year. (bls.gov, careercruising.com) Are there opportunities for advancement? By taking on more training, CNAs can move on to higher-paying roles as licensed practical nurses, registered nurses, etc. What qualities should a CNA have? To be a successful CNA, you need to be compassionate, an excellent listener, able to follow directions well, observant, dependable, a team player, a good communicator, and able to do physically demanding work. Urbana Adult Education Center (UAEC) CNA Program Facts: For over 40 years, UAEC has successfully trained over 2,500 CNAs. Our CNA instructors are licensed, registered nurses with over 50 years of combined experience. Through our partnerships with Carle Hospital and local long-term care facilities, UAEC helps provide students with job opportunities after graduation. The cost of our CNA program is significantly lower than other area programs. UAEC offers fee waiver and scholarship opportunities for CNA students. Be sure to read this entire packet in order to complete your application correctly! (We know it s a lot of information, but it s ALL important!!) 3.

4 Parking at UAEC When turning in your CNA application and arriving for orientation, please park in the designated area explained below (STUDENT PARKING LOT). If no free student parking spots are available, you will need to park in a metered spot. Please arrive EARLY so that you have enough time to find parking. FREE Student Parking (With permit. Spots 1-18 only) City of Urbana Lot 25 Free student parking is available in spots 1-18 at the west (back) end of City of Urbana Lot 25, past the spaces marked with MobileMeter signs. If you park in a MobileMeter space without paying through the mobile app, you will get a parking ticket from the City of Urbana. There is a walkway from the parking lot to Griggs Street. *Head-in Parking only Do not back into the parking space! 4.

5 Criteria for Class Selection All students accepted into Urbana Adult Education Center s CNA Program must meet requirements set forth by both the Illinois Department of Public Health and UAEC. To be eligible to APPLY for this CNA class: 1. You must have a high school diploma or GED. 2. You must be authorized to work in the United States. 3. Due to Department of Public Health requirements, clinical site regulations, and OSHA regulations, all potential CNA students must be at least 18 years of age by the first day of clinical rotations, which is March 7 th, You must not be on probation or parole. If you are currently on probation for ANY reason or parole (for ANY conviction), You are not eligible to enroll in the CNA program at this time. CNA candidates are selected for the class by UAEC s CNA Selection Committee. Criteria for selection includes, but is not limited to, the following: Reading and math test scores Successful work experience Oral and written communication skills Positive interpersonal skills Accountability Education and training Strong work ethic Attention to detail by turning in a COMPLETED application AND all required documents by the due date (December 3 rd or 4 th ). If your application is not filled out completely, or if documents are missing, it will NOT be considered. Please read this entire packet and follow all directions carefully to help improve your chances for selection! 5.

6 Health Care Worker Conviction Waiver Information If you have EVER been arrested for a misdemeanor or felony, please read the following information carefully. Thus, you will need a waiver in order to apply for this CNA Program. 6.

7 Health Care Worker Conviction Waiver Information (continued) If you have questions regarding a conviction or the conviction waiver process, please call the Illinois Department of Public Health (IDPH) at If you have a conviction that requires a waiver, you must have the letter from the Illinois Department of Public Health that states that you were given a conviction waiver, in hand, before you can apply for the CNA program. When applying for a waiver, be sure to follow all instructions very carefully. Below is a list of disqualifying convictions that may be considered for a conviction waiver by the submission of a waiver application (meaning you must be granted a conviction waiver before you can apply for the CNA class). This list (subject to change) includes both misdemeanors and felonies. For a full listing of disqualifying offenses, please refer to the website at (left-hand side, under Health Care Worker Registry). Battery, Domestic Battery, Battery of an Unborn Child Assault, Aggravated Assault Forgery Receiving a Credit/Debit Card with Intent to Use, Sell, or Transfer; Receiving a Stolen Debit/Credit Card, Selling a stolen Debit/Credit Card without the Consent of the Issuer, Using a stolen Debit/Credit Card with the Intent to Defraud Fraudulent Use of Electronic Transmission Identity Theft, Aggravated Identity Theft Theft, Retail Theft, Theft of Lost or Mislaid Property Robbery Burglary, Residential Burglary Armed Violence Criminal Trespass to Residence Child Abduction, Aiding and Abetting Child Abduction Unlawful Restraint, Aggravated Unlawful Restraint, Forcible Detention Tampering with Food, Drugs, or Cosmetics Aggravated Stalking Home Invasion Endangering the Life or Health of a Child, Cruelty to Children, Permitting Sexual Abuse of a Child Ritual Mutilation, Ritual Abuse of a Child Vehicular Hijacking Arson, Aggravated Arson, Residential Arson Unlawful Use of a Weapon, Aggravated Unlawful Use of a Weapon, Unlawful Use or Possession of Weapons by Felons or Persons in the Custody of the Department of Corrections Facilities Aggravated Discharge of a Firearm, Aggravated Discharge of a Machine Gun or a Firearm Equipped with a Device Designed or Used for Silencing the Report of a Firearm, Reckless Discharge of a Firearm, Unlawful Discharge of Firearm Projectiles Unlawful Sale or Delivery of Firearms on the Premises of Any School Manufacture, Delivery, Possession with Intent to Deliver or Manufacture Cannabis; Cannabis Trafficking; Delivery of Cannabis on School Grounds; Delivering Cannabis to a Person under 18; Calculated Criminal Cannabis Conspiracy Manufacture or Delivery, or Possession with Intent to Manufacture or Deliver, a Controlled Substance Other than Methamphetamine, a Counterfeit Substance, or a Controlled Substance Analog; Controlled Substance Trafficking Distribution, Advertisement, or Possession with Intent to Manufacture or Distribute a Look-alike Substance Criminal Drug Conspiracy; Calculated Criminal Drug Conspiracy; Delivering a Controlled, Counterfeit or Look-alike Substance to a Person under 18; Engaging or Employing Persons under 18 to Deliver a Controlled, Counterfeit, or Look-alike Substance Violations under the Methamphetamine Control and Community Protection Act Practice of Nursing without a License *Note: Some convictions are always disqualifying, except through the appeal process. This means that no conviction waiver can be obtained. A full list of always-disqualifying convictions can be found at (scroll to bottom of page). 7.

8 CNA Application Process If you are applying for the WIOA scholarship (ages only see p. 16), you will need to turn in 2 separate applications: 1) Your WIOA Application, and 2) Your general CNA class application. Please turn in your completed WIOA application and ALL supporting documents (see pp ) to Urbana Adult Education AS SOON AS POSSIBLE, by no later than Monday, November 26 th, Note that you will also need to return to UAE on one of the dates and times listed below to turn in your general class application and take your reading and math test. All CNA applicants, please return your completed class application and all required documents to Urbana Adult Education on one of the dates and times listed below. You will also take a reading & math test at this time and should expect to be here for approximately 2 hours. Please do not bring children or visitors with you. You must arrive on time! Monday, December 3 rd at 9:30 a.m. OR 1:00 p.m. Tuesday, December 4 th at 9:30 a.m. OR 1:00 p.m. Please bring the following required items with you. (Original documents only - Photocopies will not be accepted.) 1. COMPLETED class application: (pp of this packet). 2. $7.00 application fee (non-refundable). Cash, check, or debit/credit card 3. An official academic transcript*: Please determine which of the following applies to you. (If your transcript is not in English, please have it translated.) a) If you have not attended college, please bring an official high school transcript with your graduation date, or your official passing GED scores. (If you are an APL Graduate of Urbana Adult Education, you are not required to bring a high school transcript.) b) If you have attended college, but have not completed your degree, please bring a college transcript, along with your official high school transcript or official GED scores. c) If you have a college degree, please bring an official college transcript. (No high school transcript or GED scores necessary.) *Note: You may also have your transcript(s) mailed, faxed ( ), or ed (aplacido@usd116.org) to Urbana Adult Education before the application due dates. 4. Valid, state-issued driver s license or valid, state-issued photo ID (Expired IDs are NOT valid). If the address on your ID is not current, please bring proof of your current address, such as a power bill, phone bill, cable bill, etc. 5. Your social security card 6. Proof of immunizations, if any (See p. 9) 7. Illinois Department of Human Services Medical Card, if you receive one. (This is the free medical care card from the state, not your personal insurance card.) 8. If you served in the armed forces, please bring your discharge papers. 9. If applicable, please bring a conviction waiver letter from the Illinois Department of Public Health. (See pp. 6-7) 10. If you are applying for the the Hardship Fee Waiver (Ages 25 & older ONLY - see p. 16), please bring the completed fee waiver application (pp ) and ALL required supporting documents listed on p OPTIONAL: A résumé and/or professional reference letter(s) printed on company letterhead 8.

9 Please bring proof of the following immunizations: (If you have them) 1. MMR (Measles, Mumps, Rubella): Proof of immunity by titer* OR record of two doses of MMR vaccine (separated by one or more months and given on or after the first birthday) 2. Varicella (Chicken Pox): Proof of immunity by titer* or record of two live vaccinations. Documentation of having the disease IS NOT sufficient. 3. Rubeola (Red Measles): Immunization (see MMR, above) or positive Rubeola screen or titer*. Persons born prior to 1957 are considered to be immune. 4. Influenza (Flu): Vaccination for the current season is required of all students who are in class between November 1 st and April 30 th of each year. Also, if you have had a 2-Step TB Skin Test or a TB Quantiferon administered any time between March 7 th, 2018 and now, please bring proof of your negative test results. * Your immunization records may be obtained from your physician s office or from the public school which you attended. Your physician will determine which immunizations and/or titers you need to have administered. Titers can be administered at your healthcare provider location or at various lab locations, such as Frances Nelson. Immunizations can be given by your healthcare provider or at various pharmacies. You may want to wait until you find out if you are accepted into the CNA Program before you have titers or vaccines administered. If you are selected for the class, your instructor will tell you what immunizations you are missing proof of, and advise you on how to get them. If your immunizations are incomplete, you will have until the 3 rd week of class to produce proof of immunizations, or you will be dropped from the class. No exceptions! Important Dates to Remember After Applying (Please keep these dates in mind when scheduling other meetings/appointments.) On Monday, December 10 th, 2018, please call Urbana Adult Education to find out if you have been selected for the class. If selected, you will be informed of your orientation time. On the morning of Monday, December 17 th, 2018, (Time to be announced) mandatory orientation will be conducted at UAEC. The orientation process takes approximately 3 hours. On Wednesday, January 9 th, 2019, (time to be announced), students not already on the State Health Care Worker Registry will have mandatory fingerprinting. Students will need a valid driver s license or other valid state-issued photo ID in order to be fingerprinted. Fee-based students will also be required to bring the first class fee installment of $275 (or full payment of $550) AND proof that Step 1 of your 2-Step TB Skin Test was administered. (Additional information will be given at orientation.) The first day of class will be Tuesday, January 29 th, 2019, at 8:30 a.m., at Carle Hospital. 9.

10 Non-Refundable Fees $7.00 student application fee: Due at UAEC when you submit your application on 12/3 or 12/4 $ class fee*: If you are a fee-based student, the first installment of $ will be due on Fingerprint/Background Check Day, Wednesday, January 9 th, 2019 (Credit/Debit) (Checks/Money orders payable to Urbana Adult Education Center) You will have until Tuesday, February 19 th, 2019 to pay the second installment of $ *(Please see p. 16 for information on having your class fee waived) Included In Non-Refundable Class Fee: 2-Step TB Skin Test*: Any additional exams that may be needed after the 2-Step TB Skin Test (such as chest x-rays) will be the student s responsibility. If a third TB test is needed, Urbana Adult Education Center will not be responsible for the cost. You will be required to pay for the 3 rd test. (*Reminder: If you have had a 2-Step TB Skin Test or Quantiferon test performed any time between March 7 th, 2018 and now, please bring proof of your negative results.) Fingerprinting (for students NOT already on the Health Care Worker Registry) One Drug Screening: Any additional drug screenings needed will be at the expense of the student. CNA State Exam Registration Fee (one exam registration per student). Drug Screening Our clinical sites require CNA students to submit to a 10-panel drug test. If admitted into the program, you will be scheduled for this drug screening, which must be administered after the midterm exam is passed. Students test results must be negative in order to continue with the program. A drug test is a technical analysis of a biological specimen to determine the presence or absence of specified parent drugs or their metabolites. A 10-panel rapid tests for the following: Amphetamines (including Methamphetamine) Barbiturates Benzodiazepines Buprenorphine Cannabinoids (THC) Cocaine Opioids (Codeine, Morphine, Heroin, Oxycodone, Hydrocodone, etc.) Methaqualone Phencyclidine (PCP) Propoxyphene Synthetic cannabinoids (K2, Spice) Tricyclic antidepressants Methadone 10.

11 CNA Course Information This course is divided into two consecutive portions: 1) the classroom portion, and 2) clinical rotations. Part 1: Classroom Portion (Theory/Lab) The first part of the CNA course takes place in a classroom and lab setting. Taught by licensed instructors, students will learn about patient care through lectures, demonstrations, and hands-on practice. Students are assigned reading homework every day, and must pass several quizzes, as well as a mid-term exam and final exam, in order to remain in the program. Dates: Tuesday, January 29 th through Wednesday, March 6 th, 2019 Days/Time: Monday through Friday, 8:30 a.m. 12:30 p.m. Location: Carle Foundation Hospital (611 W. Park Street in Urbana) The Urbana Adult Education Center CNA Program partners with Carle Foundation Hospital. Highlights include state-of-the-art facilities, upgraded technology, and the versatility of working in a hospital and long-term care setting. This partnership allows for 25% of each CNA class to have the opportunity of becoming Carle employees. Graduates who exhibit outstanding character, compassion, dedication, and a strong work ethic may be interviewed for a Health Care Tech position at Carle. Textbook: Fee-based CNA students will be required to purchase or rent their own textbooks. It will be the student s responsibility to obtain a copy of the book before the first day of class. (Students who are granted the WIOA Scholarship or the Hardship Fee Waiver will be provided with textbooks to use for the duration of the class). o Title: Mosby s Textbook for Nursing Assistants, 8 th Edition by Sorrentino & Remmert. o Softcover ISBN-13: o Hardcover ISBN-13: o Price: Varies, depending on retailer and whether used, new, rented, etc. (Usually between $20-60.) o More information about purchasing the textbook will be given at orientation. Part 2: Clinical Rotation Portion The clinical rotation portion of the CNA course offers students the opportunity to put their knowledge into practice. Under the supervision of the instructors, students will gain experience by working with actual patients. Students must successfully demonstrate several clinical skills in order to graduate from the program. Dates: Wednesday, March 7 th through Thursday, March 28 th, 2019 o (11 days total, not counting Spring Break, which is from March 18 th through 22 nd ) Days/Time: Monday through Friday, 8:15 a.m. 12:45 p.m. Various Locations: Including Carle Foundation Hospital, Champaign-Urbana Regional Nursing and Rehab, and Clark-Lindsey Village. Attire for Labs & Clinical On lab days (beginning 2 nd week of class) and during the clinical portion of the CNA class, you will need to wear the following: scrubs, white shoes, and a watch with a second hand. The cost of this uniform is not included in the class fee. More information about class attire will be given at orientation. 11.

12 Mandatory Class Hours Please note that, because the Illinois Department of Public Health regulates this CNA course, students attendance in class and in clinicals is closely monitored. Tardiness is also monitored. There are no excused absences or tardies absent is absent, and there is a strict limit on the amount of time a student can miss. If a student misses more than the allotted time, they will be dismissed from the program. Specific information regarding attendance requirements will be given at orientation. Restriction on Vocational Hours / Previous Attendance If you have attended the Computer Skills, Office Careers, or Certified Nursing Assistant class at Urbana Adult Education previously, and you have used any or all of your allotted 180 vocational hours, you will not qualify for a Hardship Fee Waiver or the WIOA Scholarship. You will be a fee-based student and will be required to pay the full CNA class fee of $ If you have questions regarding your vocational hours, please contact us at Once you have carefully read all the information in this packet, please fill out the following application completely. Please print clearly. Incomplete or illegible applications will NOT be considered. urbanaadulteducation.org Reminder: All information in this packet is subject to change. We recommend following our Facebook and Twitter pages to receive any updates.

13 Application for CNA Class Please fill in all the blanks. This information is required in order to perform your fingerprinting. Please include ALL names used (maiden name, married name, legally changed names, etc.). Social Security Number: Date of Birth: Age: Legal First Name: Legal Middle Name (FULL middle name, not initial): Legal Last Name: Other Names Used (Including Maiden Name/s): N/A Sex: Male Female Marital Status: Single Married Divorced Widowed Address (print clearly): Are you Hispanic or Latino? yes no Are you from more than one racial group? (Please check all that apply.) American Indian or Alaskan Native Asian Black/African American Native Hawaiian/Pacific Islander White Primary Racial/Ethnic Group: (Please select only one.) American Indian or Alaskan Native Asian Black/African American Native Hawaiian/Pacific Islander White Hispanic/Latino Is English your first language? yes no Native Language (if not English): Mailing Address: City, State, Zip: County: Physical Address (if different from mailing): City, State, Zip: County: Telephone: (cell) (home) List any other states where you have lived: No other states Height: feet inches (no half inches) Eye Color: Hair Color: Weight: Place of Birth: of Birth: State: If not If U.S., not U.S., country: 13.

14 Education Information Are you currently enrolled in another educational institution? yes no If yes, where? Expected graduation date: Degree / Certificate expected to receive: If you are not currently enrolled in school, what is the name of the last school that you attended? School: Date you left: Have you ever tested, enrolled, or attended classes at Urbana Adult Education, Even Start, or Storefront before? yes no If yes, what program and when? Highest level of school that you have completed (check one): High School Diploma (bring official high school transcript, unless UAE grad) GED (bring official passing GED scores) Some College, No Degree (bring college transcript along with official high school transcript or official passing GED scores) College or Professional Degree (bring official college transcript only) School Type: USA Based School Non-USA Based School Employment/Household Information Reminder: If you would like to showcase your full work history and experience, you have the option to include your résumé and/or professional reference letter(s) with your application. (This could help improve your chances of selection for the class!) Employment Status (choose one): Employed Unemployed Not in Labor Force Employed but received notice of Termination or Military Suspension If employed, how many hours do you work per week?: Where do you work? What is your occupation? Were you referred from WIOA Core Partner or One-Stop?: yes no Name of referring WIOA Partner/One Stop: Do you receive a medical card? (free medical care from the state, not your personal insurance card) yes no If yes, what is your member/case ID number? (listed on your card): (Reminder: If you receive a medical card, you are required to bring it with you when you turn in your application.) 14.

15 Other Information Please check the box if the following applies to you: English Language Learner Disabled Homemaker Individual with a Disability Ex-Offender Exhausted 2 Years of TANF Veteran Long-Term Unemployed Migrant and Seasonal Worker Are you on probation? Are you on parole? None of the above How did you hear about our CNA program? (Please check one.) One-Stop Employer Friend/Relative Facebook Other: While at any job, have you ever been found to be guilty of abuse, neglect, or theft? yes no If yes, please explain. Have you ever been convicted of, or pled guilty to, a criminal offense other than a minor traffic violation? yes no If yes, please explain. Include the city, state, and county where it occurred. In case of an emergency, which hospital would you prefer? Carle Hospital OSF Heart of Mary Medical Center Other: Please list all medications for emergency reasons. None Also, please list any physical or emotional conditions for emergency reasons: None Emergency Contact Information: Name: Home phone: Cell phone: Relationship to you: I certify that all of the information in this application is true: Printed name: Signature: Date: 15.

16 WIOA Scholarship & Hardship Fee Waiver Information If you are NOT applying for a Hardship Fee Waiver or for the WIOA Scholarship Program, you are finished with your application. STOP HERE! If you are interested in having your $550 class fee waived, please read the following information carefully: 1. If you are between the ages of 17-24, you may be eligible for the WIOA Scholarship Program (See pp Applications are due Nov. 26 th!) 2. If you are 25 years of age or older, you may be eligible for a Hardship Fee Waiver (See pp Applications are due Dec. 3 rd or 4 th when you submit your class application) Reminder: If you have already used any of your allotted 180 vocational hours at Urbana Adult Education, you are not eligible for the WIOA Scholarship or the Hardship Fee Waiver (See p. 12). Because of the specified age requirements, you may only apply for one of the above fee waiver opportunities. Please determine which fee waiver opportunity applies to your age. Then, carefully read the corresponding instructions and fill out the application completely. Eligibility for the WIOA Scholarship or the Hardship Fee Waiver will be based on financial need, documentation, etc. You MUST bring ALL required documents listed under the option for which you are applying! Late or incomplete applications & documents will not be considered!! 16.

17 WIOA Scholarship Information for Potential CNA Students (ages only) The Workforce Innovation and Opportunity Act (WIOA) is a program that helps job seekers and workers (ages 16-24) access employment, education, training, and support services to succeed in the labor market. Urbana Adult Education offers CNA scholarships through the WIOA Program. These scholarshhips cover most of the associated costs (the $550 class fee, the textbook, and scrubs) for eligible students to earn their certifications. Urbana Adult Education and WIOA will keep in contact with students for at least one year following CNA graduation and may assist students with postsecondary education costs and employment help. In order to be eligible for the WIOA Scholarship, you must: 1. Be between years old 2. Must not be currently taking any classes when you submit your WIOA application. Note: you can be enrolled somewhere and not currently taking classes. 3. Score at a 9 th grade level or higher on a standardized reading and math exam (which you will take when you submit your general CNA application on December 3 rd or 4 th ) 4. Upon completion of the CNA program, student must go directly into the workforce in the health/medical field, or directly on to post-secondary education. 5. Show financial need/low income by meeting at least ONE of the following requirements: Receive SNAP Benefits (LINK card/food stamps) or TANF from DHS OR Have a total household income that falls under one of the categories to the right: Size of Family Unit (Number of Household Members) Total Household Yearly Income or less (Before taxes) 1 $12,060 2 $16,240 3 $21,365 4 $26,376 5 $31,124 6 $36,406 As part of the WIOA Scholarship Program, the student will be required to: 1. Attend a 2-hour intake session at the Illinois WorkNet Center in Champaign before the CNA class begins. 2. Attend all WIOA Scholarship meetings at the Urbana Adult Education Center. 3. Attend all scheduled CNA tutoring sessions until the CNA state exam is passed. (Tutoring sessions are usually held in the CNA classroom, 2 to 3 times per month, from 1:00 p.m. 2:30 p.m.) 4. Remain in good standing with the Urbana Adult Education Center CNA Program. 5. Commit to staying in contact (on a monthly basis) with the WIOA Liaison from Urbana Adult Education, for a minimum of one year, after successfully completing the CNA program. If you are interested in being considered for the WIOA Scholarship Program: Please complete the following Preliminary WIOA Scholarship Program Application form (pp ) in its entirety. Applications take several weeks to process, so they must be turned in to Urbana Adult Education AS SOON AS POSSIBLE, by no later than Monday, November 26 th, 2018 (the week before your general CNA class application is due)! You must also bring all supporting documents listed on p. 20. Late or incomplete WIOA applications and documents will not be considered! (Note that you will still need to submit your general CNA application and take a math and reading test at UAEC on December 3 rd or 4 th, in order to apply for the CNA class in general. Students applying for the WIOA Scholarship are not guaranteed to be selected for the CNA class.) 17.

18 Preliminary Application for WIOA Programs Please fill in ALL of the following required information. Please print neatly! Incomplete applications will NOT be considered. 18.

19 WIOA Application, Continued 19.

20 Please include the following required documents to complete your WIOA Scholarship application*: These documents are due when you submit your WIOA application (no later than Monday, November 26 th ) Please bring originals. Photocopies will not be *Note that some of the following documents are also required for your basic CNA application (see p. 8). If this is the case, you do not need to provide additional copies of those documents when you turn in your CNA application on December 3 rd or 4 th. 1. Proof of Authorization to Work in the United States (one of the following): o If you are a U.S. citizen, please bring your birth certificate OR U.S. passport. o If you are a non-u.s. citizen, please bring your Green Card (proof of permanent residency). o You may also bring your DD Form 214, if applicable. 2. Proof of Current Address: o Recent, Post-Marked mail showing your name and address OR o Recent bill with your name and current address 3. Social Security Card (actual card, not a letter) 4. Valid, State-Issued Photo ID (Expired IDs are NOT valid) 5. Proof of Household (Bring at least one of the following): o Medical card from DHS/government listing ALL children/family members names o OR Copy of your lease o OR Birth Certificates for ALL of your children 6. Proof of Income (ONE of the following 4 options): o If you receive food stamps, please bring documentation of your SNAP benefits (NOT your LINK card) o OR If you receive public assistance, please bring your TANF documentation o OR If your child receives free or reduced lunch (cannot be schools giving free lunch to all students), please bring documentation of this. o OR If you DO NOT receive SNAP, TANF, or free/reduced lunch, you must bring original paycheck stubs for the LAST 6 MONTHS for yourself and each additional working member of your household. 7. Official High School Transcript with graduation date or official passing GED scores 8. Selective Service Registration (Males 18 years of age and older) 9. Verification of Disability (If applicable) 10. Marriage Certificate, if you are married 20.

21 Please note: Only students age 25 years or older may apply. If you are interested in being considered for a Hardship Fee Waiver, please carefully read the guidelines on this page and complete the following application form in its entirety. The following application (pp ) must be turned in with your CNA application, along with all supporting documents listed below, on either December 3 rd or 4 th. Late or incomplete applications and documents will not be considered! Please bring original documents. Photocopies will not be accepted: Paycheck stubs for the last month for ALL members of the household, if applicable Proof of occupancy with current address (such as a power bill, phone bill, cable bill, etc.) Statement of Public Assistance Benefits (SNAP, TANF, etc.), if applicable Social Security Benefits Verification Letter, if applicable Child Support Award Letter, if applicable Unemployment Verification Letter, if applicable Documentation of any other income or financial aid you receive Step 1: Please verify that you meet income* guidelines for one of the following: Household size Annual Free Meals Federal Poverty Guidelines Monthly Twice per month Every 2 weeks Weekly Household size Annual Reduced-Price Meals Federal Poverty Guidelines Monthly Twice per month Every 2 weeks 1 15,678 1, ,311 1, ,112 1, ,044 2,504 1,252 1, ,546 2,213 1,107 1, ,777 3,149 1,575 1, ,980 2,665 1,333 1, ,510 3,793 1,897 1, ,414 3,118 1,559 1, ,243 4,437 2,219 2,048 1, ,848 3,571 1,786 1, ,976 5,082 2,541 2,346 1, ,282 4,024 2,012 1, ,709 5,726 2,863 2,643 1, ,716 4,477 2,239 2,066 1, ,442 6,371 3,186 2,941 1,471 For each addt l family member add Urbana Adult Education Center CNA Class Hardship Fee Waiver Eligibility Guidelines and Application 5, For each addt l family member add *The following is the definition of income (Please read carefully!!): Weekly 7, Income is defined as any monies earned before any deductions such as income taxes, social security taxes, insurance premiums, charitable contributions, and bonds. It includes the following: (1) monetary compensation for services including wages, salary, commissions, or fees (2) net income from non-farm self-employment (3) net income from farm self-employment (4) social security (5) dividends or interest on savings or bonds or income from estates or trusts (6) net rental income (7) public assistance or welfare payments (8) unemployment compensations (9) government civilian employee or military retirement or pensions or veteran payments (10) private pensions or annuities (11) alimony or child support payments (12) regular contributions from persons not living in the household (13) net royalties, and (14) other cash income. Other cash income would include cash amounts received or withdrawn from any source including savings, investments, trust accounts, and other resources which would be available to pay the price of a child s meal. ISBE IEG18 (4/17) 21.

22 Hardship Fee Waiver Application, Continued Step 2: Please fill out all household information. Please list ALL members who live in your household. Relationship to you (Example: mother, father, boyfriend, husband, sister, friend, partner) If the child is attending school, what school do they attend? 1. School 2. School 3. School 4. School 5. School 6. School 7. School 8. School Step 3: Please fill out income information for ALL persons in the household receiving income, public assistance, etc. List ALL household members receiving income, including yourself: List monthly income amount & include the source of income (work, public assistance, child support, social security, unemployment, alimony, pensions, assistance from a relative not in the household, etc.) ***(Remember to include documentation of these with your application!!)*** 1. Monthly Amount: Source(s): 2. Monthly Amount: Source(s): 3. Monthly Amount: Source(s): 4. Monthly Amount: Source(s): 5. Monthly Amount: Source(s): 6. Monthly Amount: Source(s): 7. Monthly Amount: Source(s): 8. Monthly Amount: Source(s): Household Monthly Total: 22.

23 Hardship Fee Waiver Application, Continued Step 4: Verify that all information is correct and sign below. I certify all information on this fee waiver application is true and ALL income is reported. I understand that if I purposely give false information, this is grounds for dismissal from the program. Date: Printed name of fee waiver applicant: Signature of fee waiver applicant: In compliance with Section 511of Public Law (the Stevens Amendment), approximately 27% or $315,874 of federal funding supports this program. Reasonable accommodations for students with disabilities are available upon request. 23.