The Independence Center CNA Training Program Enrollment Application
This application form is to be used only for students who are being sponsored by a workforce agency.
Pikes Peak Workforce Center LogoIf you need help paying for tuition for the CNA certification, please contact the Pikes Peak Workforce Center first! You can reach them at 719.667.3791.
Please read the entire application and complete the information required below.
To apply for enrollment at The Independence Center (The IC) CNA Training Program, hereafter referred to as the “Program”, read the entire application, complete the requested information fields and provide a digital signature.
Admission, Retention and Termination Policy
To promote consistency, fairness and equality in the approach and fulfillment of the requirements for The IC CNA Training Program (IC CNATP) with regards to each student who request admissions to the program as well as outlines the retention and termination policies for The IC CNATP. Includes the admission policy to The IC CNATP and basic requirements, training materials and student commitment. Sets guidelines for student retention and criteria for termination of a student who is not performing satisfactorily in either the classroom or in the clinical setting. Defines the course of completion and graduation activities, including information on how to proceed with the test application.
To select the best qualified candidates.
Applicant must be of good physical and mental health with an interest in the healthcare field. Applicant must have the ability to bend, kneel and lift at least 50 pounds.
Applicant must be at least sixteen (16) years of age. If under eighteen (18) years of age must have parent or legal guardian’s approval (located on the application) unless emancipated.
Applicant must be able to communicate clearly using the English language due to its exclusive use by the instructors and its predominant use by medical teams and medical facilities. This includes the ability to understand written and spoken English plus the ability to speak clearly, to be clearly understood, to read written English and to write clearly using the English language.
Applicant must possess a valid social security number and be legally eligible to work/train in the United States.
Applicant understands they must submit to a Tuberculosis (TB) test (which will be provided by The IC CNATP at no additional cost to the student) and have a negative reaction or a negative chest x-ray should the TB test be positive. A positive TB test and positive chest x-ray or any in-progress TB medication treatment (ABT) will result in admission denial.
Applicant must be able to pass a criminal background check in accordance with State Board of Nursing standards. Applicant must not have any convictions in any state related to patient abuse, neglect, or Medicaid fraud. There is no additional cost for the background check.
Applicant acknowledges and understands no alcohol or illicit drug use will be accommodated during any aspect of the training due to program compliance with Federal Laws. Any person deemed under the influence of marijuana, drugs or alcohol will be terminated from the program and reported to the Colorado Board of Nursing.
Applicant acknowledges they understand a minimum of seventy-five (75) hours are required by the State to complete a CNA program and meet the requirements for taking the Colorado State test. Although only 75 hours are required by the State, The IC CNATP requires 104 hours of classroom and clinical hours. Twenty (20) hours of clinical hours must be completed. Eighty-four (84) hours of classroom and lab sessions should be completed, however if an applicant has to miss time due to unforeseen circumstances the Program Administrator, Program Coordinator or the Instructors may make the decision to allow the student to continue and complete the class providing the student has documented proof as to the reason for missing hours, the student has demonstrated proficiency on tests and in skills lab and the total classroom hours does not drop below ninety two (92) hours. Clinical hours cannot be missed.
Applicant must be able to work with and interact competently with other people in a team type environment.
Applicant understands that The IC CNATP utilizes a CCTV video surveillance security system during instruction and consents to being video recorded while on the premises.
Applicants who are in their third trimester of pregnancy are recommended to speak with their doctor prior to applying for The IC CNATP. Any pregnant applicant assumes all risks and indemnifies the program from liability.
The IC CNATP will provide reasonable accommodations for people with disabilities.
Scrub Top Rental
Scrub tops will be provided by The IC CNATP as a rental for students when they attend clinical training. The Certification of Completion will not be issued until the scrub top is returned in acceptable condition. If the scrub top is lost or damaged, the student will pay a $20.00 replacement fee.
Should any enrolled student determine they will not be able to complete their enrolled course due to medical, legal or immediate family emergency, the student must:
- Request in writing a deferment to a future course be granted by the Program Administrator or Program Coordinator while their original course is still in progress.
- Provide written verification (proof) signed by a licensed professional (i.e. MD, attorney, etc).
Note, only one (1) deferment per student will be granted and no deferment will be granted until the students total remaining balance due has been paid in full prior to the end-date of their original enrolled course, regardless of the payment option initially selected. Every deferred student must complete the program within 90 days from the date their deferment was granted. All deferments become null and void after this 90-day period.
Deferment of Clinical Training Only
Should an enrolled student miss clinical orientation or any scheduled clinical training session, they will need to request a deferment in writing. Note, any student granted deferment for clinical training will not receive priority placement in any future clinical session, but rather, will be assigned to the first available clinical training session as determined by the Program Coordinator or Instructor. This could delay completion of the program up to 90 days.
To assist each student to successful completion and ensure a trained and competent individual.
The content material and skills will be continually tested throughout the course to ensure retention. Quizzes and tests will be administered periodically.
One on one assistance will be provided, and alternative learning methods will be utilized to assist in learning for those students who score poorly on homework, quizzes and/or skills practice.
Clinical Performance Monitoring
An approved clinical instructor will monitor students during their clinical hours to evaluate specific performance and be available on site for assistance. Clinical instructors will monitor no more than ten (10) students during clinical rotation.
A final post instruction examination will be administered to ensure a 75% correctness on the written and a 95% accuracy on the skills examination.
Each student will have successfully completed the skills checklist identified by the Colorado Board of Nursing with each item signed off by an approved Clinical Instructor.
Certificate of Completion
Upon satisfactory completion of The IC CNATP, the student will be provided with a Certificate of Completion indicating the approved program name, date and the training coordinators name and signature.
To redirect students who demonstrate poor suitability.
Any student who misses more than one (1) classroom, lab practice or is late to more than two (2) sessions will be terminated from The IC CNATP unless time is made up. Missed time can be made up only at the discretion of the Program Coordinator and Instructor.
A “no call/no show” will result in counselling. A second “no call/no show” will result in termination from The IC CNATP.
A student who continually fails to complete class assignments and clinical work assignments or who knowingly provides substandard work will be terminated.
Any conduct or action that:
- Involves unsafe, abusive, illegal, impaired, unprofessional, disrespectful, threatening, endangering, potentially violent or violent action or gesture made toward self or any patient/resident or their family members, or toward The IC CNATP staff, clinical site staff or fellow students.
- Exhibits any signs of mental or emotional instability.
- Falsely reports events that did not happen (lying).