CNA Interest Form

Our 75-hour, non-credit course introduces students to the principles and procedures of basic patient care. The course is regulated by the Ohio Department of Health and 100% attendance is required. The students will be given both classroom and clinical experience. An average of 80% or higher is required on quizzes and the final exam to complete the classroom section of the course and proceed to the clinical rotation.

Personal Information

First Name

Middle Name

Last Name

Email Address

Phone

Birthdate

What is your primary language?

Please select your Clark State Campus Preference

Springfield

Xenia

Beavercreek

Bellefontaine

Mailing Address

Country

Street

City

Region

Postal Code

Program Information

STNA tuition is $1200 and includes textbooks, uniforms, state exam fee and TB test. (Note: Financial Aid and FAFSA cannot be applied to non-credit courses.)

How will you be paying for the STNA tuition?*

Please provide the name of the organization and the contact name/email of the representative who is assisting you.

Organization Name

Organization Contact Name

Organization Contact Email

I have completed my fingerprinting and background check. *

Yes

No

Instructions for BCI fingerprinting will be sent to the email address provided.

Do you have any additional questions or comments?