CENTRAL ARIZONA COLLEGE
SKILLS CENTER HEALTHCARE PROGRAMS
NURSING ASSISTANT PROGRAM
INFORMATION
AND
ENROLLMENT PACKET
One-Stop / Skills Center
Job Skills Training Program
SkillsCenter6/2008
Central Arizona College-Health Professions Programs at the Skills Center
Nursing Assistant Program
The Nursing Assistant Program (CNA) is designed to prepare students to be eligible for
Nursing Assistant Certification through the Arizona State Board of Nursing and upon
certification, practice in a health care agency as a certified nursing assistant and to master
skills required to enter into the Central Arizona College Nursing Program. Students may
apply to the Nursing Program after successful completion of the prerequisite courses and
completing the admission requirements. The Central Arizona College Nursing Program
Information and Application Packets are available at the college admission and/or
advising offices on each campus.
Students wanting to enroll in the courses at the Skills Center must attend a Skills Center
CNA Orientation and/or speak with the Skills Center Manger or designee to request and
receive information for enrollment into the Certified Nursing Assistant program.
Upon satisfactory completion of HPM 125 Nursing Assistant course, the student is
eligible to receive a certificate of completion. Each student must apply for the certificate
of completion by the specific date of graduation checkout, approximately 6 - 8 weeks
before the end of the program (Refer to the Class Schedule).
Central Arizona College reserves the right to change, without notice, any costs, materials,
information, curriculum, requirements, and regulations in this publication.
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CNA ENROLLMENT INFORMATION
Central Arizona College / Skills Center is in partnership with Arizona Workforce Connection to create a
One-Stop/Skills Center where students can receive services from state job agencies and college
services/classes all within one building. One of the key goals of the Skills Center is to afford students a
seamless, uncomplicated process with a complete grouping of course offerings to secure employment
upon completion. To foster this key goal, all program offerings at the Skills Center are arranged in
“cluster groupings.” The cluster grouping, for the CNA program, include three additional classes:
Introduction to Healthcare, Employment Readiness Program Part I and Part II. ALL costs of the cluster
grouping courses at the Skills Center for the Certified Nursing Assistant program, are covered in
the cost of the program, $2,315 (price is subject to change without notice). This includes tuition, loaner
textbooks, student workbooks, materials, supplies, physical, and background check.
Those wishing to register for the cluster grouping of courses at the Skills Center for the CNA Program
must submit a Request for Enrollment form and provide documents following the outline described
below.
The courses, as approved by the Dean of Healthcare and Sciences, are Introduction to Healthcare, CPR
for the Professional, Certified Nursing Assistant, and Employee Readiness Parts I and II.
Steps to Request Enrollment:
1. Carefully read through the directions for requesting enrollment into the cluster grouping of courses
for the Certified Nursing Assistant (CNA) at the Skills Center.
2. If you have questions about the process, please contact:
Penny Miller, Skills Center, Program Specialist 520-494-6603, [email protected]
Or
MaryCecilia Gutierrez, Skills Center, Manager 520-494-6605, [email protected]
3. Complete the Request for Enrollment forms included in this packet.
4. Complete the Health and Safety Documentation Checklist and Health Care Provider Signature Form
found in this packet. Students need to follow directions for submitting their health documents as
described on the Health and Safety Documentation Checklist in order for their application to be
considered complete. The TB skin test must be completed within the last 6 months and the CPR
card within the last 12 months (CPR is one of the classes included in the cluster grouping.)
Students should keep their original documents for their records. Only copies of documents should
be submitted with the packet. If copies are needed, please bring originals in for copies to be made.
Once the college accepts documents, documents will not be returned to students.
5. Students enrolling in the cluster grouping of courses are responsible for payment either personally or
through agency referral. All of the courses are eligible for financial aid. Students are responsible
for their expenses IF their referring agency does not pay for their classes.
6. Students need to take the ASSET test at the Skills Center OR obtain copies of referring agency’s
reading/writing tests.
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7. Submit the following documents to Penny Miller or MaryCecilia Gutierrez at the Skills Center
in an envelope with your name or stapled together. The following information needs to be included.
a. Request for Enrollment form
b. Health and Safety Documentation with all documents attached
c. Health Care Provider Signature Form
d. Agency reading/writing test scores if using them
8. Completed Skills Center CNA program packets will be processed in the order they are received.
Students submitting all of the required documentation will be notified when they may come to the
Skills Center to register. Only ten (10) students are allowed in the class at a time.
Process to Enroll in the Skills Center CNA Program:
Students are able to register for the class, once Request for Enrollment forms are checked by the
Skills Center Manager, the Program Specialist, the Professor of the CNA class or designee to make
sure all the requirements are complete. Please allow at least two (2) weeks for this process, once
you have submitted all the paperwork.
When all the requirements are met and space is available, the student will receive notification via email, phone, and/or mail of their acceptance into the CNA class. Once students are notified, they are
required to come into the Skills Center / Corporate Center to register for the class(es) due to the
cluster grouping. The agreement form for student participation in the program from the referring
agency should be on file with the college prior to submitting the enrollment packet. If it is not,
however, then a hold may be placed on the student’s enrollment until the referring agency sends the
appropriate paperwork. This may prohibit you from attending the class. A waiting list will be kept
(first come/first secure) and maintained for the current class and future program classes. Students
not referred by an agency will initiate a contract with the Skills Center for third party billing. This
allows for financial aid to pay the Center directly for tuition, materials, supplies, physical, and
background check.
As a reminder, space is limited; only ten (10) students per class.
Students will be contacted when a future class is being held to determine if they want to enroll in
that class. If they have changed their minds about the Skills Center CNA program , then their
application will be destroyed (shredded). They will have to submit a new application if they change
their minds at a later date.
Please, do not phone the office more than once a week once you have submitted an application. It
takes time to review and confirm the documents. The Skills Center will contact you by e-mail,
phone, or mail to let you know if you can enroll in the CNA class.
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Additional Information for Enrollment into Skills Center CNA classes:
Any student not attending class or clinical on the first day will be withdrawn from the course.
The Nursing Assistant courses have strict attendance policies and students are expected to
attend each class session.
All students registered for the Nursing Assistant course MUST OBTAIN A BACKGROUND
CHECK from Verified Credentials. The website address is www.myvci.com/centralaz. The
background check is forwarded to the Skills Center Manager only: for placement in your Nursing
Assistant file at the end of the course. Only those students who have no Discrepancy found on the
check will remain in the program.
Nursing Assistant Uniforms: For the clinical experience students must wear forest green scrub
top, white or forest green scrub pants, and white shoes. These will be provided for you through the
program. A CNA supply form will be given to you at the time of registration - please fill out this
form - AND RETURN IT TO PENNY MILLER.
Students who begin the Skills Center CNA cluster grouping of classes and decide not to finish the
program for any reason, MUST inform their referring agency AND meet with the Skills Center
Manager as well as drop class(es) through Penny Miller at the Skills Center. Students who drop the
cluster grouping of courses prior to the beginning of the Certified Nursing Assistant class will have
the costs prorated. Students dropping after the Certified Nursing Assistant class has started will be
charged the entire Skills Center fee of $2,445.
Materials needed in the classes will be handed out during the respective class.
o books / workbooks / notebooks
o Stethoscope / cuff
o Watch with second hand
o Uniform needed for clinicals
o White shoes for clinicals
Upon successful completion of HPM 125 students are eligible to take the
examination for certification as Nursing Assistants administered under the
guidelines of the Arizona State Board of Nursing. This examination is not
provided through the Skills Center at Central Arizona College. It is a separate
examination for certification through the Arizona State Board of Nursing and
taken off-site of the college. Information as to the dates and times of the
examination will be provided to students. The cost for obtaining certification is
approximately $150.00.
Contact the ASBON at http://www.nursing.state.az.us/ or 602-889-5150.
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INFORMATION FOR STUDENTS
ZERO TOLERANCE POLICY: The Central Arizona College Skills Center Nursing Assistant Program
supports a Zero Tolerance Policy for the following behaviors:
o Intentionally or recklessly causing physical harm to any person on the campus or at a clinical site, or
intentionally or recklessly causing reasonable apprehension of such harm.
o Unauthorized use or possession of any weapon or explosive device on the campus or at a clinical site.
o Unauthorized use, distribution, or possession for purposes of distribution of any controlled substance or
illegal drug on the center or at a clinical site.
Nursing Program student engaging in this misconduct is subject to immediate dismissal from nursing classes
and disciplinary action as described in the Student Handbook of the college will be taken.
HEALTH DECLARATION: It is essential that nursing assistant students be able to perform a number of
physical activities in the clinical portion of the program. At a minimum, students will be required to lift
patients, stand for several hours at a time, and perform bending activities. Students who have a chronic
illness or condition must be maintained on current treatment and be able to implement direct patient care.
The clinical nursing assistant experience also places students under considerable mental and emotional
stress as they undertake responsibilities and duties impacting patients’ lives. Students must be able to
demonstrate rational and appropriate behavior under stressful conditions. Individuals should give
careful consideration to the mental and physical demands of the program prior to applying.
All students entering the Nursing Assistant Program must meet all Health and Safety requirements to
maintain enrollment status for CNA courses. Students will meet these requirements by providing all
documents attached to the Skills Center, which includes the Health/Safety Requirements Documentation
pages and the “signed” Health Declaration Form from your health care provider.
BACKGROUND CHECK: All students are required to obtain a background check. Access the website
by going to www.myvci.com/centralaz. Only those students who have no Discrepancy found on the check
will remain in the program.
WAIVER OF CERTIFICATION GUARANTEE: Admission or graduation from the Central Nursing
Assistant Program does not guarantee obtaining a CNA certificate. Certification requirements and the
subsequent procedures are the exclusive right and responsibility of the Arizona State Board of Nursing.
Students must satisfy the requirements of the Nurse Practice Act: Statutes, Rules, and Regulations,
independently of any college or school requirements for graduation.
Pursuant to A.R.S. § 32-1606(B)(17), an applicant for professional or practical nurse
license by examination is not eligible for licensure if the applicant has any felony
convictions and has not received an absolute discharge from the sentences for all
felony convictions. The absolute discharge must be received five or more years before
submitting this application. If you cannot prove that the absolute discharge date is
five or more years, the Board cannot consider your application.
All Nursing Assistant applicants for certification and licensure will be fingerprinted to
permit the Department of Public Safety to obtain state and federal criminal history
information. All applicants with a positive history are investigated. If there is any
question about eligibility for licensure or certification, contact the nursing education
consultant at the Arizona State Board of Nursing (602-889-5150).
*Fees are subject to change by the Central Arizona Community Colleges Governing Board. All costs
quoted are subject to change.
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REQUEST FOR ENROLLMENT INTO SKILLS CENTER CNA PROGRAM
(PRINT) Name _______________________________________Student ID Number
Phone #:
880
.
Day________________________ Evening_____________________ Cell _____________________
Mailing Address______________________________________________________________________________
City_________________________________ State _____________________Zip__________________________
(PRINT) E-Mail Address______________________________________________________________________
E-mail, phone, or mail will be used to contact you about enrolling for classes.
DIRECTIONS:
Students need to fill out the following documents AND have their doctor or other medical personnel
complete the Health Care Provider Signature Form. Submit all completed documents in an envelope
or stapled together with your name on them to Penny Miller or MaryCecilia Gutierrez at the Skills
Center. The documents are as follows:
o Request for Enrollment Form
o Health and Safety Documentation Checklist (with all documentation attached)
o Health Care Provider Signature Form
o Agency reading/writing test scores if using them
Penny Miller will give students a CNA Supply Form to complete at the time students submit their
Request for Enrollment packet. Please fill out this form immediately and return it to Penny.
Enrollment requests for the cluster grouping of courses are on a first come / first secured basis; space
is limited to the first ten (10) students for the actual CNA course. A waiting list will be taken and
maintained for current and future CNA classes.
I have completed and attached the following documentation for enrollment:
Check when completed prior to handing in the packet
_____ Copies of the completed documentation required on the Health and Safety Documentation
Checklist and Health Care Provider Signature Form found in this packet.
_____ Copies of your TB skin test (which must be completed within the last 6 months)
_____ Copies of your CPR card (needs to be issued within the last 12 months)
(CPR course is part of cluster grouping.)
_____ Copies of your reading and writing tests scores from referring agency OR complete the
ASSET/COMPASS test with the college (prior to submitting your enrollment packet).
I am requesting permission for registration into the Skills Center CNA cluster grouping courses offered
through the Skills Center, Job Training Program.
Campus: Skills Center
Class Group Date_________________________________
CRN#s________________________________
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CENTRAL ARIZONA COLLEGE SKILLS CENTER NURSING ASSISTANT PROGRAM
HEALTH AND SAFETY DOCUMENTATION CHECKLIST
Applicant: ______________________________________________
Date: ______________
Home Phone: _____________ Cell Phone:_____________ Student ID Number:
880
.
A. MMR (Measles/Rubeola, Mumps, Rubella): Requires documented proof of two MMRs in
lifetime or a positive titer for each of these diseases.
1st MMR Date: _______________
2nd MMR Date: _______________
OR
Date & results of titer: Measles/Rubeola ________ Mumps _________ Rubella ___________
Circle: Yes or No
I have attached documented proof as specified above.
B. Varicella (Chickenpox): Requires documented proof of (2) vaccinations or positive IgG titer.
1st Varicella Date: ________2nd Varicella Date: _______OR Date & results of IgG titer: ______
Circle: Yes or No
I have attached documented proof as specified above.
C. Tetanus/Diphtheria (Td) immunization within the past 10 years.
Td Date: _______________
Circle: Yes or No
I have attached documented proof as specified above.
D. Tuberculosis: Documentation of an annual TB skin test (PPD). If positive skin test, provide annual
documentation of chest X-ray negative for evidence of disease, or written documentation of a TB
disease free status from a licensed health care provider. All testing must have been completed
within the previous six (6) months.
PPD Date: ________ Date of Reading: ______ Results (circle):
Negative
OR
Chest x-ray Date: ____________ Results: ___________________________
Circle: Yes or No
OR
Positive
I have attached documented proof as specified above.
E. Hepatitis B: Documented evidence of completed series or positive antibody titer. If beginning
series, first injection must be prior to admission and the series completed within 6 months.
Date of 1st injection: _____________
Date of 2nd injection: ____________
Date of 3rd injection: _______________
Circle: Yes or No
OR
Hep B Titer Date: _______________
Titer Results: _________________
I have attached documented proof as specified above.
F. CPR Card: Health Care Provider
Date CPR card Issued: _______
Expiration Date: ________
Circle: Yes or No I have attached a copy of both sides of the CPR Card. CPR certification must have been
completed within 12 months. CPR course is part of cluster grouping of courses.
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CENTRAL ARIZONA COLLEGE SKILLS CENTER NURSING ASSISTANT PROGRAM
HEALTH AND SAFETY DOCUMENTATION CHECKLIST
IMPORTANT: Students are responsible for maintaining their own health records. The Health
Careers Department accepts only photocopies of all documentation of health related materials.
The Health Careers Department does not retain copies of immunization records, CPR
certification, nor TB skin test results in student files. Students are responsible for maintaining
their own records of current CPR certification and proof of negative TB skin tests until
completion of the program. Copies of proof of these updates must be submitted to the Health
Careers Department when due.
All immunization records must include your name, name and signature of the healthcare provider giving
the immunization, and date. A health care provider’s signature on the Health Declaration form,
without proof of immunization status, is NOT acceptable.
IMMUNIZATIONS
A. MMR (measles/rubella, mumps, rubella)
Options to meet this requirement:
a. Attach a copy of proof of two previous MMR vaccinations to the health declaration form.
OR
b. If you had all three illnesses OR you have received the vaccinations but have no
documented proof, you must have a titer drawn for each illness.
i. If the titer results are POSITIVE, attach a copy of the results to the health declaration
form.
ii. If the titer results are NEGATIVE, you must get your first MMR vaccination and
attach documentation to the health declaration form. The second MMR must be
completed within one month and proof submitted to the nursing department.
B. VARICELLA (chickenpox)
Options to meet this requirement:
a. Attach a copy of proof of a positive IgG titer for varicella.
OR
b. If the titer is NEGATIVE, attach a copy of proof to the health declaration form that you
received the first vaccination. Complete the second vaccination in 4 to 8 weeks and
submit proof to the nursing department.
C. TETANUS/DIPHTHERIA (Td) immunization within the past 10 years.
Attach a copy of proof of Td vaccination to the health declaration form.
D. TUBERCULOSIS
Options to meet this requirement:
a. Attach a copy of proof of a TB skin test (PPD) completed within the previous 6 months
and results. Records for PPD (skin testing for tuberculosis) require name and signature
of the healthcare provider, and findings.
OR
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CENTRAL ARIZONA COLLEGE SKILLS CENTER NURSING ASSISTANT PROGRAM
HEALTH AND SAFETY DOCUMENTATION CHECKLIST
b. If you have a POSITIVE TB skin test you must submit a copy of proof of a chest x-ray
completed within the previous 6 months and its results. Provide evidence of disease free
status.
E. HEPATITIS B
Options to meet this requirement:
a. Attach a copy of proof of completion of three Hepatitis B injections to the health
declaration form. HbsAB antibody titer to the health declaration form.
b. If you have not received the injections in the past, you must obtain the first injection and
attach a copy of proof of the injection to the health declaration form. You must receive the
2nd injection in one month and the 3rd five months after the second. Submit documentation to
the nursing department.
F. CPR Card: Must be a Health Care Provider
Attach a copy of both sides of the CPR card to this form. CPR certification must include infant,
child, and adult, 1 and 2 man rescuer, and evidence of a land-based demonstration component.
CPR certification must have been completed within 12 months. CPR course is part of cluster grouping of
courses.
Instructions for Completion of Health Care Provider Signature Form
A health care provider must sign Health Care Provider Signature Form and indicate whether the
applicant will be able to function as a Nursing Assistant student. Health care providers who qualify to
sign this declaration include a licensed physician (M.D., D.O.), a nurse practitioner, or physician’s
assistant.
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CENTRAL ARIZONA COLLEGE SKILLS CENTER NURSING ASSISTANT PROGRAM
Health Care Provider Signature Form
(Please Print)
Applicant Name_______________________________ Student ID Number__880________________
It is essential that nursing students be able to perform a number of physical activities in the clinical
portion of the program. At a minimum, students will be required to lift patients, stand for several hours
at a time and perform bending activities. Students who have a chronic illness or condition must be
maintained on current treatment and be able to implement direct patient care. The clinical nursing
experience also places students under considerable mental and emotional stress as they undertake
responsibilities and duties impacting patients’ lives. Students must be able to demonstrate rational and
appropriate behavior under stressful conditions. Individuals should give careful consideration to the
mental and physical demands of the program prior to making application.
I believe the applicant _______ WILL OR _______ WILL NOT be able to function as a nursing
student as described above.
If not, explain: ______________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Licensed Healthcare Examiner (M.D., D.O., N.P., P.A.)
Print Name: ________________________________________________
Title: __________________________
Signature: _________________________________________________
Date: __________________________
Address: ______________________________________________________________________________________________
City:
___________________________________________ State:
______________________________________________
Phone: _______________________________
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CENTRAL ARIZONA COLLEGE SKILLS CENTER NURSING ASSISTANT PROGRAM
Health Care Provider Signature Form
(PRINT) Name __________________________________________Student ID Number___880______________________
(PRINT) E-Mail Address_______________________________________________________________________________
Campus Contact/Nursing Assistant Faculty Check (Initial for verification)
This is your check off sheet to make sure you have all of the paperwork required
for your packet.
Checklist:
_____ Documented proof of MMR (Measles/Rubella, Mumps, Rubella) immunity or vaccination
_____ Documented proof of Varicella (Chickenpox) immunity or vaccination
_____ Documented proof of Tetanus/Diphtheria (Td) immunization within the past 10 years.
_____ Documented proof of a Tuberculosis free status within 6 months.
_____ Documented proof of Hepatitis B immunity or vaccinations.
_____ Documented proof of CPR certification within 12 months.
_____
Health Care Provider Signature Form
_____
Unofficial transcript showing scores on the ASSET or COMPASS Test
_____ Background check completed.
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