Kentucky Health Care Training Institute
The next available class is The class times are 8:00 a.m. to 1:00 p.m.
Enclosed is an application form for the class. If you are interested in the class, please call 502-458-4570 to set an appointment to enroll.
YOU MUST HAVE THE FOLLOWING WITH YOU AT TIME OF ENROLLMENT:
Kentucky Health Care Training Institute does not discriminate in employment or enrollment on the grounds of race, gender, color, age, national origin, sexual orientation, or disability.
Refund Policy - If a student cancels the class by 3:00 the Thursday before the class begins, $125.00 will be refunded. If the student does not cancel by 3:00 the Thursday before the class begins, the $50 no show fee will be deducted from the $125.00 refund. Once the student has attended any part of the class, there will be no refund.
There is an attendance policy in this class. If a student misses more than 6 hours, the student will be dropped from the class. The student must also maintain a 70% grade point average to complete the course. Class must be attended on the first day or the student will not be registered in that course.
Mailing Address ___________________________________________________
City, State, Zip Code _______________________________________________
Telephone Number _____________ SSN __________________________
Is the documentation verifying high school diploma or GED included with the application?
YES _________ NO ____________
Is CURRENT documentation verifying status on the Kentucky Nurse Aide Registry included with the application?
YES ____________ NO ____________
Is proof of professional liability insurance included with the application?
YES _______ NO ________
Has above applicant been employed as a nurse aide in long-term care for at least 6 months in the last 2 years?
YES _____________ NO __________________
THIS MUST BE SIGNED BY A REPRESENTATIVE OF A FACILITY IN WHICH THE APPLICANT HAS WORKED FOR 6 MONTHS AS A NURSE AIDE IN THE LAST 2 YEARS.
Signature and title of facility representative Date
PLEASE NOTE- ALL SPACES MUST BE COMPLETED. ANY QUESTIONS THAT HAVE BEEN ANSWERED “NO” WILL RESULT IN THE APPLICATION BEING REJECTED.
Refund Policy- If a student cancels the class by 3:00 the Thursday before the class begins, $125 will be refunded. If the student does not cancel by 3:00 the Thursday before the class begins, the $50 no show fee will be deducted from the refund. Once the student has attended any part of the class, there will be no refund.
A student in the program is not allowed to miss more than 6 hours of class. If any more than 6 hours of class is missed, the student will be dropped from the course. The student may not miss any clinical hours. A grade point average of 70% and a grade of 70% on the final exam are required in order to complete the course.
I certify that the information on this application is correct and complete to the best of my knowledge. I also understand the grade and attendance policy for this program and the refund policy as outlined above. I understand that I must be in uniform each day of the class.
Signature of Applicant Date