Certified Nurse Assistant (CNA) Spring 2018 Application Packet

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CNA-SP Professional & Community Education 4203 S. Providence Rd Columbia, MO 65203 Ph: 573-214-3803 Fax: 573-214-3811 Certified Nurse Assistant (CNA) Spring 2018 Application Packet Thank you for your interest in the Certified Nursing Assistant Program sponsored by Columbia Area Career Center. This classroom-based, instructor-led program will help you develop the background knowledge and skills you need in preparation for the examination to become a certified nurse assistant. This letter explains the important considerations of the application as well as information on our program. CNAs work closely with patients and are responsible for assisting with Activities of Daily Living (ADL) such as bathing, grooming and feeding patients, assisting nurses with medical equipment and checking patient vital signs. CNAs give patients important social and emotional support and also provide vital information on patient conditions to nurses. This program includes classroom instruction and clinical experience in area skilled care facilities. Classroom instruction in a certified nursing assistant program includes basic nursing skills, anatomy, physiology, nutrition and infection control. Students also gain hands-on experience during clinical activities. CNAs work in nursing homes, hospitals, mental health facilities, assisted living facilities and private homes. Job prospects for CNAs are expected to be excellent due to the increasing longterm care needs of an aging population. CNA is an excellent entry into the nursing profession. GENERAL PROGRAM INFORMATION Class will meet Monday and Wednesday evenings, from 5:30pm to 9pm beginning January 22, 2018 through May 9, 2018. The Missouri Department of Health and Senior Services requires any candidate sitting for the CNA Exam must have completed 75 classroom hours and 100 hours of clinical experience. Therefore, you must attend ALL classes and complete ALL clinical hours to successfully complete this course to be eligible for the CNA exam. The tuition and textbook for the Spring 2018 section will be $1025. Tuition may be paid in 3 payments of $500 (due January 18, 2018), $265.00 (due February 22, 2018), and $260.00 (April 5, 2018) if needed. Additional costs will be incurred by the student for proper attire to be worn during clinical hours. For CNA certification, $20 in cash will be required to send to The Missouri Association of Nursing Home Administrators.

An application fee of $45 is required with the application. Also, applicants must pass a drug and alcohol test and register with the Family Care Safety Registry. The drug test must be arranged by the applicant with Runde Occupational Professionals, 3700 I-70 Drive SE, Ste.106 (no appointment needed). The basic test is $15. The results will be faxed to the Professional and Community Education Office. Instructions on registering with the Family Care Safety Registry are included in this packet. ADMISSION CRITERIA Accurate completion of the application (form enclosed) $45 application fee, payable by cash, check or M/C, Visa, or Discover Registration with the Family Care Safety Registry (instructions included in packet), registration fee is $13 and must be paid with a credit/debit card on FCSR website Clean drug screening from Runde Occupational Professionals, 3700 I-70 Drive SE, Ste.106; no appointment is necessary and the cost is $15, payable when you are tested Letter of intent (form enclosed) Letter of professional recommendation from an employer or instructor in support of your application (form enclosed) Possible Interview (to be held after application deadline) Two-Step TB Testing prior to clinical experience (results no later than January 29, 2018) Copy of Driver s License and Social Security Card ADMISSION TIMELINES APPLICATION DEADLINE Thursday, January 11, 2018 at 4:00pm ** Application is incomplete until we receive the results of the drug screen and proof of registration with FCSR (Family Care Safety Registry). Friday, January 12, 2018 Review of applications, possible interviews, and acceptance letters sent. Thursday, January 18, 2018 Tuition due; Students using the payment plan must pay the first installment of $500 to hold their spot in the CNA program. Monday, January 22, 2018 - Classes begin.

Columbia Area Career Center complies with the Americans with Disabilities Act and will provide reasonable accommodations for individuals with disabilities. If you require special arrangements for testing, you must submit the following: Documentation of disability by a qualified professional. (This documentation must not be more than 3 years old and should be based upon adult norms.) Request for accommodations. Please allow 30 days for accommodations to be coordinated. Direct your requests to: ADA Coordinator, Columbia Area Career Center, 4203 S. Providence Rd., Columbia, MO 65203. Mail the application packet to: Admissions Committee/CNA Program Columbia Area Career Center Professional & Community Education Room 147 4203 South Providence Road Columbia, MO 65203 Or via email: adulted@cpsk12.org The Columbia Public School District does not discriminate on the basis of race, color, religion, sex, sexual orientation, national origin, ancestry, disability, age, or use of leave protected by the Family and Medical Leave Act, in its programs, activities, or with regard to employment. The Columbia Board of Education is an equal opportunity employer. Columbia Area Career Center is committed to providing equal access educational opportunities for students with disabilities covered under The Americas with Disabilities Act. The objectives are to ensure that students with disabilities function adequately and without discrimination in all aspects of the educational experience. Accessible facilities are available at all training locations. Students with documented disabilities who would like to inquire about the availability of reasonable academic and/or other pr ogram related accommodations should contact the Section 504 Liaison, 214-3800 ext.

COLUMBIA AREA CAREER CENTER PROFESSIONAL & COMMUNITY EDUCATION Certified Nurse Assistant Spring 2018 Please complete this application as accurately as possible in typed form or print legibly in ink. Application for Spring 2018 program must be received by January 11, 2018. GENERAL INFORMATION Last First Middle Maiden/Former Name Current Address City State Zip Home Phone Cell Phone Social Security Number Email address Sex Date of Birth Emergency Contact Phone Number WORK EXPERIENCE Employer Name & Address Dates of Employment Basic Duties Employer Name & Address Dates of Employment Basic Duties PROFESSIONAL REFERENCES please list 3 Name, Company/School, & Phone # Relationship Name, Company/School, & Phone # Name, Company/School, & Phone # Relationship Relationship List any current certificates, licenses, or other credentials: List any previous employment, training, workshops, seminars, or other educational opportunities you have experienced related to the healthcare field. I certify that the above information is correct and complete. I understand that I am responsible for notifying the Program Director of any changes of address or phone number. I also understand that I am responsible for my own transportation to and from clinical sites and may be required to obtain a physical examination prior to beginning clinical experiences. Signature Date

Instructions for Registering with the Family Care Safety Registry (FCSR) You must register with the Family Care Safety Registry before being accepted into our CNA program. If you need access to a computer, please contact our office at 573-214-3803. The fee for registering online is $13 ($12 registration fee and $1 processing fee) and must be paid by credit or debit card. Once you have registered please submit proof of registration with application packet. If you have previously registered with the FCSR you do not need to reregister. Please print the page that shows you are already registered and submit with your application. - Go to the following link http://www.health.mo.gov/safety/fcsr - Click on Register On Line - Read and follow the Online Registration Instructions - Print two copies of the receipt, one copy for your records and one for submission with the application packet

Deadline for receipt of application packet is January 11, 2018. Professional & Community Education Certified Nurse s Assistant Spring Program Letter of Intent Please discuss your interest in the CNA Program in the space provided below. Include in your discussion how these interests have developed, why you wish to become a CNA, and what you plan to do upon completion of this program. Please include in your response why specifically you want to work with elderly people. Also give examples of experience you have had before helping people. Name of Student Signature Date

Deadline for receipt of application packet is January 11, 2018. Professional & Community Education Certified Nurse s Assistant Spring Program Letter of Recommendation Form Application to the Certified Nurses Assistant requires a letter of recommendation. Please utilize this form to submit your recommendation. Applicant s Name Please provide information below that led to your recommendation of this applicant. Name Relationship to applicant Phone Number E-mail address Signature Date