Virginia CNA Interested Candidates

If you are interesting in training with us to become a nursing assistant, please answer all of the questions below to the best of your ability. If you need more information about the program, please visit our website at https://www.heritagecare.org/nursing-educational-services

NOTE: If you plan to apply for WIOA funding, it is VERY IMPORTANT to check the Virginia Career Works Eligibility Determination Appointment page on a daily basis. Appointments are very difficult to get. Once you see one, take it no matter what and we will help you get everything prepared before your appointment. The sign up website can be found here.

https://www.signupgenius.com/go/10C0548ADA623A5FA7-wioa6#/

Today's Date

Last Name

First Name

E-Mail

Phone Number

Primary Language

Other Languages Spoken

Work Permission in the U.S.

Able to Work 40 Hours

High School or GED

Street Address

City

County

Availability

Funding

How do you plan to fund your training? If you are unsure about the three options, please review the funding options under the Virginia Nursing Assistant Training Program section.

Government Assistance

Do you or your family receive any type of government assistance? (SNAP, WIC, TANF, SSD)

Proof of Income

Are you able to provide recent paystubs or benefit statements for all adults in your household?

Proof of Household Size

If you are married or have children, are you able to provide your marriage certificate and/or birth certificates for all children in the household?

Consent for Text Messages

Please indicate if you agree to receive text message updates about WIOA appointment availability and class updates. HCI will not message you for any reason not related to the VA CNA training program. HCI will not share or sell your number.

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