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Loftinedu.com
Home
About
Our Classes
Pricing Table
Enrollment Application
Our Commitment
Testimonials
Contact
Important Information
Course Catalog
Enrollment Application
Training for a Better Future
All information is required and must be supplied in order for this application to be considered.
Full Name
*
E-mail
*
Date of birth (Click month to change years)
*
Date of birth (Click month to change years)
Phone Number
*
Age
*
Highest Grade Completed
High School
GED
Some College
Associate's degree or higher
List any allergies
*
List any medical conditions that you would like to declare
*
List any recent hospitalizations or surgeries that may require restricted activity.
*
List emergency contact information
*
Have you been convicted, at any time, of any crime other than a minor traffic violation?
Yes
No
In no more than 100 words, tell us why you want to be a nursing assistant.
*
Send Application
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You can submit this form only once.
Admissions@loftinedu.com
1909 West 87th Street, Chicago, IL, USA