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HMC EDU INTAKE

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Program / Service? *

Have you ever been a licensed CNA before? *

Have you ever attended an CNA program and failed to complete? *

Have you ever been convicted of a crime (misdemeanor/felony) ? *

Did you attend high school? *

Were you in need and or provided any special accommodations for your learning style? *

I authorize Help Me Care Edu to contact me via SMS/ text msgs regarding my student application and alumni benefits. Msg and data rates may apply, select STOP to opt out *

I understand that the tuition assistance programs are 3rd-party sponsored can last from a period of 4 to 6 weeks providing I am eligible and I take the necessary steps that are asked of me

Tuition Path

Are you currently employed? *

Are you willing to work as a PC/HHA to help pay for your tuition? *

Do you have children under the age of 18 that reside in the home with you? *

If yes, are you the custodial parent/ legal guardian?

Do you receive SNAP benefits in the state of OHIO?

Have you ever attended Ohio Means Jobs before to apply for funding? *

Are you sponsored by a nursing home and or another facility? *

Did you win a free tuition in a Help Me Care raffle? *

Authorization

I understand there is a strict NO REFUND POLICY *

I authorize Help Me Care Edu to contact me about my application and or any educational/Alumni opportunities via SMS/text msgs . Msg and data rates may apply, select STOP to opt ou *

I understand that I will need a Tb shot, a background check, high-school transcripts in addition to my funding path in order to attend this program *

I authorize Help Me Care to run a background check and or check my references. (If applicable) *

I understand that if I choose the self-pay option, my first payment must be made 5 business days prior to my cohort start date. *

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