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ENROLL TODAY!

Home

About

Get Funding

Registration

Contact

(0)

ENROLL TODAY!

ENROLL TODAY!

NOTE: This registration form is for prospective students only.

Name *

First Name

Last Name

Email *

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Subject *

Message *

Daytime Phone Number *

(###)

###

####

Evening Phone Number

(###)

###

####

Education/Enrollment

Have you graduated from High School?

Yes

Have you passed the GED?

Yes

Not Applicable

Are you at least 16 years old?

Yes

Are you currently a High School:

High School students must secure permission through their school principal (see form below)

Sophomore

Junior

Senior

N/A

Have you ever been convicted of a felony? *

Yes

If so, list

Can you commit to 14 days of class?

Attendance Is Mandatory!

Yes

If the session is full, do you want to be put on a waiting list?

Yes

Excelling Nursing Academy supports students with disabilities.

Are you an applicant with a documented disability?

Yes

If yes please explain:

Is English your first language?

Yes

If not, what is your first language?

Why do you want to attend the CNA course?

What personal qualities do you think a successful CNA should have?

Are you thinking of making healthcare a career? If yes, what area of healthcare are you considering?

Certification

I certify that all the answers given in this application are accurate to the best of my knowledge. I understand that failure to disclose or falsifying information could result in my dismissal from the CNA course.

Enter Your full name below as a signature

Today's Date *

YYYY

Thank you for registering! We will contact you with next steps.

Print these forms and submit them to the Academy at the address below:

High School Permission form (if applicable)

Get in touch.

It all begins with an idea. Maybe you want to launch a business. Maybe you want to turn a hobby into something more. Or maybe you have a creative project to share with the world. Whatever it is, the way you tell your story online can make all the difference.

Email *

Message *

Thank you!

CLASS HOURS
Monday-Saturday
4:00pm-10:30pm

OFFICE HOURS
Monday-Friday
9:00am-5:00pm

Excelling Nursing Academy

Farmington Hills, MI 48334
Detroit, MI 48235

248-313-2275
info@excellingnursingacademy.com

Non-Discrimination Clause
Excelling Nursing Academy does not and shall not discriminate on the basis of race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, or military status, in any of its activities or operations. These activities include, but are not limited to, selection of students, hiring and firing of staff, selection of volunteers and vendors, and provision of services. We are committed to providing an inclusive and welcoming environment for all members of our staff, clients, volunteers, subcontractors, vendors, and clients. Excelling Nursing Academy is an equal opportunity employer. We will not discriminate and will take affirmative action measures to ensure against discrimination in employment, recruitment, advertisements for employment, compensation, termination, upgrading, promotions, and other conditions of employment against any employee or job applicant on the bases of race, color, gender, national origin, age, religion, creed, disability, veteran's status, sexual orientation, gender identity or gender expression.