Step 1 of 4
Date of Application is required.

Personal Information

First Name is required.
Middle Initial is required.
Last Name is required.
Please provide a valid email address.
Phone Number is required.
Social Security Number is required.
Please provide a valid date of birth.

State ID ∕ Driver License

State is required.
ID ＃ is required.
Please provide a valid expiration date.

Emergency Contact

Name is required.
Phone is required.

Guidelines

  1. Colorado State Board of Nursing regulations state an applicant must not have a license revoked through any state healthcare regulatory agency.
  2. All students must provide a negative TB shot record within a 12-month timeframe at the time of enrollment for classes.
  3. You may need proof of influenza vaccination during the months of October through March. This requirement will be based on the policy of the skilled nursing facility where clinical instruction will take place. If vaccinations have not been performed, a waiver will be required that we will provide.
  4. All applicants must NOT have felony, misdemeanor or pending charges. Any charges or convictions will be reviewed by the Program Coordinator and approve or deny enrollment of the program.
  5. All student applicants agree to a Criminal Background Investigation check. This is a requirement by the Colorado State Board of Nursing.
  6. The online portion and lab hours of this CNA course must be completed prior to you attending the clinical portion but can be done simultaneously as your online hours. All Labs hours must be completed within our lab setting with the instructor and all clinical hours will be completed within a long-term care facility with the instructor.
Step 2 of 4

Code of Conduct

Patient Care:

  • Treat all patients with respect, dignity, and compassion, regardless of their condition or background.
  • Maintain patient privacy by protecting confidential information.
  • Follow all established procedures for patient care, including proper hygiene practices.
  • Report any changes in patient condition, concerns, or suspected abuse to the nurse immediately.
  • Never perform procedures you are not trained to do.

Professionalism:

  • Dress appropriately and maintain good personal hygiene.
  • Arrive on time for clinical rotations and adhere to scheduled shifts.
  • Communicate effectively with patients, families, and healthcare team members.
  • Be respectful towards instructors and peers.
  • Maintain a positive and professional attitude.

Academic Integrity:

  • Complete all assignments honestly and independently.
  • Cite sources properly when using information from others.
  • Do not plagiarize or cheat on exams.
  • Report any instances of academic dishonesty witnessed.

Attendance and Punctuality:

  • Attend all classes and clinical rotations as scheduled.
  • Notify instructors in advance if you need to miss a class.
  • Arrive on time for all scheduled activities.
  • Any tardiness later than 10 minutes, may result in a student having to retake that lab session.

Safety and Compliance:

  • Follow all safety protocols in the clinical setting.
  • Immediately report any accidents or injuries.
  • Adhere to all HIPAA regulations regarding patient privacy.

Ethical Conduct:

  • Do not accept gifts or gratuities from patients or their families.
  • Avoid discussing personal issues with patients.
  • Report any suspected abuse or neglect of patients.
Applicant Signature

Clear Signature

Draw your signature above
Date is required.
Instructions:
• Use your mouse or finger to sign
• Sign clearly within the box
• Click "Clear" to start over

if Applicant is a minor

Parent/Guardian Signature

Clear Signature

Draw your signature above
Date is required.
Instructions:
• Use your mouse or finger to sign
• Sign clearly within the box
• Click "Clear" to start over
Step 3 of 4

Sponsorship

Please let Colorado CNA School know if you have sponsorship that will cover the cost of the course. There are several different sponsorships that will help students with the payment for nurse aide training classes. If you are using sponsorship for payment, you must let Colorado CNA School be aware when signing this application.


Reimbursement

Students acknowledge that refunds will not be made due to a student failing to complete the program. Students are responsible for their attendance and completing the program outlined by the State of Colorado and the Colorado CNA School’s curriculum and guidelines.


Address History (5-year requirement)

The state requires 5 years of residence history. Please provide address history below:

Current Address is required.
City is required.
required
Zip Code is required.
Please provide a valid start date.
Please provide a valid end date.


Previous Address is required.
City is required.
Zip Code is required.
Please provide a valid start date .
Please provide a valid end date .


Previous Address is required.
City is required.
Zip Code is required.
Please provide a valid start date .
Please provide a valid end date .


Previous Address is required.
City is required.
Zip Code is required.
Please provide a valid start date .
Please provide a valid end date .
Step 4 of 4

Background Consent

By signing below, I agree and authorize Colorado CNA School to obtain and/or verify any and all information contained within this application, and obtain additional information including but not limited to a criminal and civil history, National sex offender check, Colorado Adult and Child Protection Services check. I authorize all persons, schools, companies, and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies, and law enforcement authorities from any liability for any damage whatsoever for issuing this information.

Applicant Signature

Clear Signature

Draw your signature above
Date is required.
Instructions:
• Use your mouse or finger to sign
• Sign clearly within the box
• Click "Clear" to start over

if Applicant is a minor

Parent/Guardian Signature

Clear Signature

Draw your signature above
Date is required.
Instructions:
• Use your mouse or finger to sign
• Sign clearly within the box
• Click "Clear" to start over

Applicant attests to the following:

  • I have read and understand this entire application and understand the requirements that need to be met to be accepted into Colorado CNA School.
  • I must pass my criminal background investigation with CBI and the Program Coordinator must approve any charges I might have.
  • I am aware that I must have proof of my TB shot results, a copy of my Flu shot record (during flu season), and I may have to have proof of my COVID vaccination (this requirement will be based on the policy of the skilled nursing facility where clinical instruction is held).
  • I’m aware of the school policy and procedures that I must follow and I’m aware if I choose not to follow, I can be terminated from the program.

The information that I have provided for this Enrollment Application is correct to the best of my knowledge.

Name of Applicant is required.
Applicant Signature

Clear Signature

Draw your signature above
Date is required.
Instructions:
• Use your mouse or finger to sign
• Sign clearly within the box
• Click "Clear" to start over
Name of Parent∕Guardian if Applicant is a minor is required.
Date is required.

if Applicant is a minor

Parent/Guardian Signature

Clear Signature

Draw your signature above
Date is required.
Instructions:
• Use your mouse or finger to sign
• Sign clearly within the box
• Click "Clear" to start over

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