Personal Care Aide (PCA) Deposit

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$200.00

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$200.00 deposit is non-refundable

Uniform: White scrub top - we provide you with one

Uniform : Black pants - student's responsibility

RequirementBe at least 18 years old
The ability to read and write English
All tattoos must be covered
Nails must be short with no artificial covering
No facial piercings
Only ear lobe piercings allowed
Long hair must be pulled back
No head scarves or wraps(unless for religious purposes), no caps or hats when in uniform

Is someone else using their credit card to register the student for class? If so, please provide credit card owners First and Last Name, Address and Phone Number. *

Student First Name * Maximum of 1000 characters

Student Last Name * Maximum of 1000 characters

Student Email Address * Maximum of 1000 characters

Have you ever been convicted of threatening another person, assault, battery, or theft? If so, please place your initials here to acknowledge you are aware these charges may prevent you from getting a job as a PCA * Maximum of 1000 characters

How did you hear about us? * Maximum of 1000 characters

Please type in the date of the class you are registering for (see class dates below) * Maximum of 1000 characters

Please enter your initials to acknowledge you have read our program requirements regarding tattoos, facial and ear piercings , artificial nails and length of nails, and head scarves, head wraps, caps and hats * Maximum of 1000 characters

Female or Male? *

Student Address * Maximum of 1000 characters

Why did you decide to enroll in this class? * Maximum of 1000 characters

Please enter your initials to acknowledge you have read our policy regarding the refundable and non-refundable portion of your deposit and/or payment. * Maximum of 1000 characters

Scrub top size * Maximum of 1000 characters

Student Phone Number * Maximum of 1000 characters

Date of birth * Maximum of 1000 characters

Have you ever been convicted of a felony? If so, please place your initials here to acknowledge you are aware these charges may prevent you from getting a job as a PCA * Maximum of 1000 characters

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