Nurse Assistant Training Program Application MISSION STATEMENT ADMISSION REQUIREMENTS BACKGROUND CHECKS/BARRIER CRIMES

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1 Nurse Assistant Training Program Application The American Red Cross Nurse Assistant Training Program meets the Virginia Board of Nursing s 120-hour requirement for Nurse Assistant Training in Virginia. The expectation of excellence is high in this fast-paced and focused program. Your instructors are highly-experienced Registered Nurses dedicated and committed to your success. Through lecture, video, role-playing, and hands-on laboratory and clinical practice, you learn procedural skills such as bathing, dressing, positioning, and vital signs. You also learn key communication techniques to provide compassionate care for people within the health care system. Our classroom/lab is equipped with hospital beds and all necessary medical equipment to practice skills. After graduation, you will be eligible to sit for the Virginia Certified Nurse Aide (CNA) exam. MISSION STATEMENT The mission of the Red Cross Nurse Assistant Training program is the preparation of Nursing Assistants who provide high quality and compassionate care for residents in nursing homes, assisted living facilities, private homes, and patients in hospitals. This course is based on the American Red Cross Six Guiding Principles of Care: Dignity- Independence-Communication-Safety-Infection Control-Privacy. ADMISSION REQUIREMENTS At least 17 years of age Read and write English at a 8 th grade level Provide proof of negative PPD test or negative chest x-ray if PPD is positive, and pass a 5-panel urine drug screen. See your healthcare provider, community clinic or urgent care center for more information. Clear criminal background check through the American Red Cross. Note: The lab and clinical sessions require strenuous activity. If you have any conditions that could affect your ability to participate, including pregnancy, chronic condition or an injury, please attach written permission from your physician to this application, stating you are cleared to participate without restrictions. Applicable conditions revealed after enrollment without physician s permission to participate will be grounds for non-refundable dismissal. BACKGROUND CHECKS/BARRIER CRIMES Certain criminal convictions may prevent certification as a nursing assistant in Virginia, and/or prohibit employment in certain health care settings. Some criminal convictions, also known as Barrier Crimes will prohibit employment in nursing home facilities, home care organizations, hospice programs and assisted living facilities. Please refer to the link below for the, Joint Statement of the Department of Health and the Department of Health Professions on Impact of Criminal Convictions on Nursing Licensure or Certification and Employment in Virginia. Click the link below or go to this site for more information: You will need to also print and sign page 10 of this document. If you have any further questions, please contact the Virginia Board of Nursing at No refunds are provided if you enroll and a background check does not clear.

2 ATTENDANCE POLICY The Virginia Board of Nursing mandates that our training program teach a minimum of 120 hours. Therefore, all classroom and clinical attendance is MANDATORY in order for you to graduate. In case of an emergency or illness which results in time being missed you are to contact your nurse instructor immediately and then contact the program manager within 24 hours to discuss your situation. DRESS CODE For your health and safety and of those around you, adhering to the dress code is expected at all times. Classroom: Comfortable Casual Clinical Rotation: Red collared long or short sleeve shirt with white scrub pants Clean white shoes with non-skid soles (not backless) Limit jewelry to a plain band and simple post earrings. No facial jewelry Nails trimmed not extending beyond tips of fingers. No colors or designs Hair must be pulled back and off your shoulders Watch with a second hand. Identification Badge: American Red Cross, Nursing Assistant Training Program photo and identification badges will be provided. Your photo identification must be worn during your entire clinical rotation. STUDENT AND ACADEMIC POLICY You are expected to come prepared to class with all homework assignments completed. The passing standard is 80% or above on all quizzes and the final exam. All skills listed in the Virginia Nurse Aide Candidate Handbook will be performed with 100% accuracy. In the clinical setting you are expected to demonstrate respect, truthfulness, reliability, timeliness and good judgment in providing safe care to residents. Cheating is grounds for immediate dismissal from the program with forfeit of all fees. REGISTRATION INFORMATION Tuition: $1,250.00, (payable by cash, credit card or money order, made payable to: American Red Cross. Memo line: NATP Tuition) For qualified military spouses we are a MyCAA Approved Tuition Assistance Program sponsored through the Department of Defense. For more information please contact them at Full tuition is due prior to the start of class. A $ non-refundable deposit is required to hold a space in a particular session and will be applied to the total tuition amount.

3 Your Tuition Includes: Additional Requirements (Not Included): All classroom, lab and clinical instruction All Textbooks and class/lab materials Stethoscope/Blood Pressure Cuff American Red Cross Photo ID Badge American Red Cross Nursing Assistant Pin Validated Parking American Red Cross Background Check. Red Collared Shirt White Scrub Pants Clean white non-skid shoes (not opened) Watch with a second hand Cost of PPD test or Chest X-Ray Cost of 5 panel urine drug screen. OVERVIEW DAYTIME CLASS Class meets Tuesday, Wednesday, Thursday and Friday 8:00 am 4:00 pm (3 weeks) Clinical rotation Monday, Tuesday, Wednesday, Thursday and Friday-7:00 am 3:30 pm (1 week) CPR/AED/First Aid Training is usually held Monday between 8:00 am-1:00 pm second week of class. OVERVIEW EVENING/SATURDAY Class meets: Tuesday, Wednesday and Thursday 6:00 pm 10:00 pm; Saturday 8:00 am 4:00 pm (4 weeks) Clinical rotation: Tuesday, Wednesday and Thursday - 5:30 pm 9:30 pm; Saturday 7:30 am 4:00 pm (2 weeks) CPR/AED/First Aid Training is usually held Monday between 5:00 pm-10:00 pm second week of class. Classroom Location Clinical Site American Red Cross 123 N. Alfred Street ; or [email protected] or [email protected] Fax: Goodwin House 4800 Fillmore Avenue Metrobus and DASH Accessible Mapquest Link: Bus and Metro Accessible; Blue and Yellow Line on Metro

4 AMERICAN RED CROSS NURSE ASSISTANT TRAINING PROGRAM APPLICATION PLEASE PRINT LEGIBLY, ENTER OR TYPE Last Name: First Name: Middle: Address: City: State: ZIP: Telephone: DAY ( ) NIGHT: ( ) Address: Are You 17 or Older ( ) YES ( ) NO If you are not a U.S. citizen do you have a Permanent Residence Card? ( ) YES ( ) NO Requested Class Start : How Did You Learn About Our Program? Background Or Employment Experience Related To Health Care If Any: Do You Have Regular And Reliable Transportation? ( ) YES ( ) NO Have You Ever Had Action Taken Against You Or Been Denied A License Or Certification In Any Healthcare Field In Any State If yes, Please Explain in Detail Below: Certain criminal convictions may prevent certification as a nursing assistant in Virginia, and/or prohibit employment in certain health care settings. Have You Ever Been Convicted and/or Charged with a Felony or Misdemeanor? ( ) YES ( ) NO If Yes, Please Explain in Detail Below: A clear criminal background check is required. Failure to list charges and/or convictions is grounds for immediate, non-refundable dismissal at any time. The Lab/Clinical Session Requires Strenuous Activity. Do you have any conditions that would affect your ability to participate such as a chronic condition, injury, or pregnancy? ( ) YES ( ) NO. If YES, please submit a physician s release allowing you to participate in the program without restrictions.

5 CNA PROGRAM 2012 Daytime Class Start Class End January 3, 2012 January 30, 2012 February 7, 2012 March 5, 2012 March 13, 2012 April 9, 2012 April 17, 2012 May 14, 2012 May 22, 2012 June 18, 2012 June 26, 2012 July 23, 2012 (will come on Monday 7/2, no class 7/4) July 31, 2012 August 27, 2012 September 4, 2012 October 1, 2012 October 9, 2012 November 5, 2012 November 8, 2012 December 10, 2012 (no class 11/22, 11/24) Evening/Saturday Class Start Class End January 17, 2012 February 28, 2012 March 6, 2012 April 17, 2012 April 24, 2012 June 5, 1012 June 12, 2012 July 24, 2012 (will come on 7/2, no class 7/4) July 31, 2012 September 11, 2012 September 18, 2012 October 30, 2012 November 1, 2012 December 18, 2012 (no class 11/22; 11/24) November 1 Evening Class starts on a Thursday November 8 Day class starts on a Thursday Red Cross Holidays: 1/2; 1/16; 2/20; 5/28; 7/4; 9/3; 11/12; 11/22-23; 12/25 Updated: 04/09/2012