STEPPING STONES EDUCATIONAL SYSTEM, INC.
2012 28th Street, Suites B & C
Grand Rapids, MI 49508
TELEPHONE (616) 245-1255, FAX (616) 245-1253
CNA PROGRAM APPLICATION
NAME: LAST FIRST MIDDLE
PREVIOUS NAME CLASS START DATE AM OR PM
DATE OF BIRTH SS#
ADDRESS DRIVERS LICENSE#
CITY STATE ZIP CODE
EMERGENCY CONTACT PERSON PHONE#
EDUCATION LEVEL: 8 9 10 11 12 HIGH SCHOOL COLLEGE 1 2 3 4
RACE SEX Male/Female
HAVE YOU EVER BEEN CONVICTED OF A FELONY OR MISDEMEANOR? YES NO
DO YOU HAVE LATEX ALLERGIES? YES/NO. ARE YOU OR MAY YOU BE PREGNANT? YES/NO
DO YOU HAVE ANY MEDICAL RESTRICTIONS OR CONDITIONS? YES/NO
YOU MUST BE ABLE TO LIFT 50 LBS.
STATE LAW REQUIRES THAT WE DO A CRIMINAL BACKGROUND CHECK FOR ANY PERSON WHO WILL WORK
WITH THE ELDERLY POPULATION. THIS INFORMATION IS USED FOR THAT PURPOSE ONLY. UPON
REQUEST WE WILL GLADLY PROVIDE YOU WITH A COPY OF THIS REPORT.
…….to the honorable career of Nursing Assistant.
Congratulations on your decision to join the exciting, challenging, and rewarding field of health care. You have
made a wise career choice to learn important skills in the rapidly growing area of long-term care.
Nursing Assistants are the “heart” of long-term care, devoted to improving the quality of life for residents. Your
skills, along with a caring attitude, will be rewarded with friendship and trust of the residents, respect of your
employer and co-workers, and personal satisfaction.
Our program is an 85 hour, 15 day or evening training program. Classes are held Monday thru Friday from 8:00
a.m. to 2:30 p.m. for the days and evening classes are from 4:00pm to 10:30pm. Class consists of lecture,
lab and clinical. Clinical portion is conducted at an area nursing facility. Upon completion of the
course, clients will be given the opportunity to take the state test to become Competent in Evaluated Nurse
Assistant (CENA). However, clients can work using the program completion certificate up to four (4) months prior
to taking the state certification test.
Program Fee and Refund Policy: $975 Tuition
All tuition and fees paid by the applicant shall be refunded if the applicant is rejected by the school before enrollment less a $25 administrative fee. An application fee of not more than $25.00 may be retained by the school, if the application is denied or if the student cancels their enrollment after the three business days.
All tuition and fees paid by the applicant shall be refunded, if requested within 3 business days after signing a contract with the school.
Once the 3 business days have elapsed the following policies will apply:
If a student does not attend class as scheduled, or if they call and cancel their class on or prior to the start date; they will forfeit the down payment of $200.00. All tuition paid will be refunded minus down payment of $200.00. If a student is being sponsored, the sponsoring agency will be charged according to the policy. Once a scheduled class begins there will be no refunds granted.
If a student is eligible and would like to re-apply, they will need to submit a new application and pay the full tuition.
*Refunds will be processed within 30 days.
Applicant Date Stepping Stones Representative Date