Registration Phone Hanmi Nurse Aide Education Program APPLICATION FOR ADMISSION Please fill first two pages of this application completely and mail to the address at the bottom. Please print Title Mr. Ms. Mrs. Prof. Dr. First Name * Middle Name Last Name * Date of Birth * Gender (Female or Male) * Social Security Number * Email Address School Attended : High School / College Emergency Contact Name/ Tel No/ Relationship Medical Field Experience Tution : $1,200 Text Book Fee : $70 Total : $1,270THE ABOVE INFORMATION IS TRUE ACCURATE TO THE BEST OF MY KNOWLEDGE Signature - Agreement (Answer ; Yes or No) * Application date * Hanmi Nurse Aide Education Program CRIMINAL SCREENING First Name * Middle Name Last Name * Address * Have you ever been convicted by any court, of a crime other than a minor traffic violation? (Yes or No) * Applicant Agreement (Yes or No) * Application date * If you answer "yes" to this question, you must supply the following information to the Department of Public Health, Nurse Assistant Certification Section. Dates and nature of the incident(s) Disposition of the case (provide court papers) Current status Letters from probation Officer (if applicable) Letters of Recommendation (if applicable) Mail to [ Hanmi Nursing School, 6214 Old Keene Mill Ct Springfield, VA 22152-2327 or just Registration Right Now] Telephone : (703) 303-3939, (703) 303-0988, Fax : (703) 569-0600 Email : CSChomecare@gmail.com Paypal Payment Tution : $1,200 Text Book : $70 Total : $1,270 [wp-paypal-product prodname=”Total”]
