CNA Application

Welcome to Río Hondo’s Health Science and Nursing Program. We invite you to apply to join our program. Please note that all correspondence will go through the email address you provided.

Before you begin your application, please have the following items ready.

Your Río Hondo student ID 9-digit number
Working email address
California ID or California driver’s license
Valid social security card or individual taxpayer identification card that is signed and not laminated

The name on all identifications must read the same name or match. (NO EXCEPTIONS)

March 2, 2025 – March 23, 2025, for Fall 2025 Start
August 15, 2025, to September 12, 2025, for Spring 2026 Start

Name(Required)

First Middle Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number(Required)

Cell Phone Number

Personal Email(Required)

Primary Email(Required)

Rio Hondo Student I.D. Number(Required)

Gender(Required)

Female

Non-Binary

Male

Age(Required)

Date of Birth(Required)

Ethnicity(Required)

Race(Required)

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Other

Primary Language Spoken at Home(Required)

Other Proficient Languages(Required)

Name of person to notify in case of Emergency

Emergency Contact Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number

Cell Phone Number

CNA Certification

Applicants applying to the Home Health Aide or Acute CNA Program MUST provide a copy of a valid CNA certificate.

CNA Certificate

Drop files here or

Max. file size: 7 MB, Max. files: 2.

Print and Sign

I understand I may not add any additional documents to this application once it has been submitted.

Print Name(Required)

Signature(Required)

Date(Required)

Upon submission, you will receive an email confirmation with a copy of your submission. If you do not receive a confirmation in a few minutes (check SPAM), please contact us.

Name of person to notify in case of Emergency

CNA Certification

Print and Sign

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