This application form is to be used with a credit or debit card payment. Make sure to have your payment card handy because it will ask for payment at the end of the form. Form cannot be submitted without your credit card details.

Cards accepted: Visa, MasterCard, American Express, Discover, Diners Club, JCB

3 CNA School: For Credit/Debit Students only: CNA School Application

The Independence Center CNA Training Program Enrollment Application

(For Students Paying by Credit or Debit Card)

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.

No high school diploma or GED is required to enroll but this course requires a substantial amount of reading and study. The textbook reads at a 10th grade level and reading assignments occur daily. Pop-quizzes, multi-choice tests and homework assignments are also issued.

PROGRAM ACCEPTANCE STANDARDS

To be accepted into The IC CNA Training Program, Applicant must meet the following Program Acceptance Standards, hereafter referred to as “Standards”, and attest to such by signing ENROLLMENT APPLICATION. Failure to meet Standards will result in denial of admission.  

  1. Due to board of nursing regulations, Applicant must not have had a license revoked through any state healthcare regulatory agency.
  2. Applicant must be physically able to bend, kneel and lift at least 50 pounds; be able to stand for periods of time; be able to understand classroom and skills lab lectures and stethoscope sounds.
  3. The State exam is the same for everyone regardless of whether the licensed CNA will be taking care of family or clients; therefore Applicant acknowledges and understands the Program adheres to one standard grading and assessment policy that applies to all students regardless of whether the Applicant plans to work with family or clients.
  4. Applicant acknowledges they could come in contact with latex, vinyl, acrylic, synthetic foams, alcohol, menthol, sanitizing chemicals, detergents, or other chemicals, material types or products commonly used in medical facilities during the skills lab and the clinical setting.  Applicant assumes the full risk of possible exposure to any of these products or chemicals that, for some, could pose a major health or life-threatening reaction. Applicant assumes full responsibility and will hold The IC CNA Training Program or the clinical facility harmless should he or she come in contact with and have a reaction to known allergens. If Applicant does have such allergies, Applicant will be required to keep an EpiPen (epinephrine injector) on his or her person at all times and a have full understanding of its use and application. (During clinical days, instructor will keep EpiPen on his or her person at all times in the event of major allergic reaction requiring the use of the pen.)
  5. Applicant must be able to communicate using the English language due to its exclusive use by Program instructors and its predominant use by medical teams and medical facilities. This includes the ability to understand English plus the ability to speak, to be clearly understood, to read English and to write using the English language.
  6. Applicant must be able to interact competently with other people in a team type setting.
  7. Applicant must possess a valid social security number and be legally eligible to work/train in the United States.
  8. Applicant agrees to provide to the Program no later than the 7th scheduled class of the course, a Tuberculosis test result that confirms a NEGATIVE TB status or a chest x-ray that reads negative for TB. This test result must be signed by a licensed medical professional and performed/dated no more than 12 months prior to the start date of the course and must not expire prior to class completion. Failure to meet this 7th scheduled class deadline will result in being denied further training. Applicant must provide NEGATIVE TB test results prior to reinstatement into a future course. A "positive TB result" or any in-progress TB medication treatment (ABT) will result in denial of admission. There will be no exceptions to this requirement and no refunds will be granted.
  9. Applicant must have NO felony or misdemeanor pending charges or prior convictions in ANY state involving ANY sex related crimes or ANY crimes related to: murder, attempted murder, assault, battery, kidnapping, abduction of a minor, aggravated menacing, aggravated robbery, grand theft, patient abuse, patient neglect, Medicaid fraud, insurance fraud or any pending charges or convictions involving the abuse, neglect or harassment of a minor or elderly person or person who was in Applicant’s entrusted care. ANY pending charges or prior convictions involving cocaine, crack, heroine or methamphetamine will result in an admission denial.
  10. Applicant agrees to have a national Criminal Background Check (CBC) completed with the results delivered to the Program by the background check processing agency no later than the 7th scheduled class of the course. This is a mandatory requirement by Program and the Colorado State Board of Nursing for all enrolled students. The CBC must include each state Applicant has lived in within the past seven years. Applicant must request the CBC by completing the requested on-line forms at theiccnabackgroundcheck.com. The costs of the background check must be paid directly by the Applicant/student unless Applicant is sponsored by an agency or organization (if this is the case, please contact The IC CNA Training Program for instructions). Cost of the background check can be obtained by calling AMERICAN DATABANK GROUP based in Denver, Colorado at 1-800-200-0853. NO background check can be accepted directly from Applicant; it must be provided by the background check processing agency. All background results are automatically received by the Program and if those results confirm no conflicts with the Program Acceptance Standards then Applicant WILL NOT BE CONTACTED regarding his/her results. Should the background check confirm a conviction for any felony or misdemeanor crime listed in Program Acceptance Standard No. 7, then Applicant WILL NOT be able to participate in the clinical training; WILL NOT be able to complete the course; and NO REFUNDS will be granted.
  11. Applicant acknowledges that ATTENDANCE IS MANDATORY ON THE FIRST DAY OF CLASS AND AT ALL CLINICAL PHASE TRAINING SESSIONS and that ONLY 7 TOTAL HOURS of pre-clinical training can be missed. If greater than 7 total hours are missed, Applicant understands further training will be denied and Applicant’s Student Contract may be terminated. Reinstatement into the next available course requires payment of a $150 fee by the Applicant plus Administrator's approval. This reinstatement option must be requested within 45 days from the student's last day of attendance.
  12. Applicant acknowledges and understands that no alcohol or marijuana use will be tolerated 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 the Board of Nursing will be notified.
  13. Applicant understands that The IC CNA Training Program utilizes a CCTV video surveillance security system during instruction and consents to being videotaped during instruction.

PROGRAM ENROLLMENT FEE PAYMENT OPTIONS

NOTE: Program Enrollment Fee is inclusive of training materials, scrub top, blood pressure cuff and stethoscope, gait belt, TB test and flu vaccine (season warranting), and state testing fee.

OPTION A:   $895 Program Enrollment Fee

1-Step Payment Plan: Payment in-full required prior to start of the course.

 OPTION B:   $895 Program Enrollment Fee

2-Step Payment Plan: $450 advance payment required prior to start of the course. Then, payment of $445 (remaining balance due) prior to participation in the clinical training phase of the course.

SEATING POLICY:

Enrollment Application submitted without the required payment will NOT be further processed for enrollment and no seat will be reserved. Seating is limited and will always be dependent upon the number of paid enrollments previously received and processed by The IC CNA Training Program. Once all seats have been reserved, enrollment for that course is closed. Applicant will be contacted if seat is unavailable for requested start date. Once Enrollment Application is accepted, a Student Enrollment Contract will need to be completed on the first day of class to finalize the enrollment. Therefore, mandatory attendance is required on the first day of class. No paid enrollments may be transferred to any other person once a course has started.

REFUND POLICY: 

Refunds for any withdrawal are ONLY GRANTED UP UNTIL THREE CALENDAR DAYS (72 HOURS) PRIOR TO THE FIRST DAY OF CLASS. NO REFUNDS will be granted after that point. NO REFUNDS will be granted if a student requests a deferment to any future course or drops out at any time during the course and NO REFUNDS shall be granted if a student is expelled. Refunds shall be for the amount paid minus applicable bank fees and charges.

DEFERMENT POLICY:

Should any enrolled student determine that they will not be able to complete their enrolled course after that course has started, then the student must: 1) Request in writing that a deferment to a future Program course be granted by the Administrator of The IC CNA Training Program; and 2) pay a $150 DEFERMENT FEE to cover necessary administrative amendments. All requests for a deferment to any future course, regardless of reason, will require the Deferment Fee and will extinguish any and all rights to a refund on the Enrollment Fee.

MINOR POLICY:

Applicants under the age of 18 must provide a written letter of consent signed and dated by a parent or legal guardian authorizing the Applicant to enroll in and attend The IC CNA Training Program. The letter must be attached to this Enrollment Application. The parent or legal guardian must agree in writing to assume all financial responsibilities for payment of the prospective student’s total Program cost and must verify that the Applicant meets the Program Acceptance Standards.


* Indicates that the field is required
 

 

City
State/Province
Zip/Postal
Drop a file here or click to upload Choose File
Maximum upload size: 8.39MB
Written letter of consent must authorize the prospective student under the age of 18 to enroll in and attend the Front Range Nurse Aide Training Program.
$
City
State/Province
Zip/Postal
By signing below, Applicant attests:

  • I have read and understand this entire Enrollment Application and I understand and meet each of the Program Acceptance Standards;
  • I authorize the results of the criminal background check to automatically be provided to The IC CNA Training Program and understand that I will not be contacted regarding the results unless a conflict/problem is evident;
  • I acknowledge and understand the Refund Policy, Deferment Policy, Seating Policy and Minor Policy;
  • The information provided in this Enrollment Application is true and correct to the best of my knowledge.
Sending