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

Student First Name *

Student Last Name *

Female or Male? *

Date of birth *

Student Address *

Student Phone Number *

Student Email Address *

Scrub top size *

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 *

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 *

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

How did you hear about us? *

Why did you decide to enroll in this class? *

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

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 *

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