Promise Healthcare Training Center

REGISTRATION FORM

Online

Apply online by filling out the form below

Mail

Download and complete the registration form and mail it to the training center.

Registration

REGISTRATION FORM
Promise Healthcare Training Center
3610 Dodge Street, Suite B10 Omaha, NE 68131
402-968-4786

Payment for tuition and fees must be included with this enrollment form. Make a copy of this form for your records.

A student’s Social Security number is required as a condition of enrollment. A student’s Social Security number constitutes an “educational record” under the Federal Educational Rights and Privacy Act (FERPA). That information will be disclosed only with the consent of the student or in those very limited circumstances when consent is not required by FERPA.

Gender *
Resident Status *
Race (used for statistical purposes only)

Course Title: Basic Nursing Assistant and Medication Aide Training
76 hours for C.N.A (completed in 2 weeks)
40 hours for C.M.A (completed in 1 week)

I am interested in *
Registration fee, Tuition, Textbook and Testing for C.N.A = $500.00
Registration fee, Tuition and Textbook for C.M.A = $385.00
Exam Fee for C.M.A (payable to Providence Healthcare Institution) = $20.00
Contact Cheryl Walburn at 402-326-2792
State Exam fee for C.M.A (payable to DHHS) = $18.00
Choose your payment method

Make checks and money orders payable to:
Promise Healthcare Training Center
3610 Dodge Street, Suite B10
Omaha, NE 68131
Phone 402-968-4786
E-mail: naenyealoziem@yahoo.com