Registration
Form:
Click here to download
the Registration Form as a :
word
document
Click here to download
the Student introduction letter as a :
word document
Registration
Form:
Please mail
or hand deliver this form with your $200.00 deposit made out to
Health Service & Education.
Tuition is
$865. The balance of $665.00 will be due on the first day of
class, unless other payment arrangements are made.
Payments are
accepted via cash, check, money order, credit card or paypal. A
$25.00 service fee will be applied for payment plans.
Name
______________________________________________________________________________
First
Middle
Last
Address_____________________________________________________________________________
City/State/Zip________________________________________________________________________
Phone
#_____________________________________Alternate phone
#__________________________
Date of
Birth_____/_____/_____ Social Security
#_____-___-_____ email:______________________
Place of
employment:
Usual work
schedule:
Please write
a brief note: Why would you like to become a Nurse Aide? What
goals have you set in obtaining this certification?
Mail to:
Health
Service & Education
Kathleen May
Adult Nurse
Aide Program
11073
Warwick Blvd Suite #G
Newport News
VA 23601
Email:
naclass@live.com