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Certified Nursing Assistant

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Applying For*
First Middle Last
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Have you completed*
Criminal History*
Have you ever been convicted of theft/abuse/neglect of an elderly person or child?
Demographic Data
Eye Color*
Include a work history for the most recent 24 months. Include work place, supervisor/contact, phone/address and a brief description of your responsibilities.
Include a work history for the most recent 24 months. Include work place, supervisor/contact, phone/address and a brief description of your responsibilities.
How did you hear about Heart to Heart?*
Choose a program start date*
Include a brief description of post completion plans.
Program and Cost*
I understand that the CNA Training Program is a full-time, 3 week day or a part-time 5 week evening, 130 hour program that includes classroom & clinical training. The total cost of the program is $1050 may be paid by the student or a sponsoring agency, if applicable. Cost includes: Program Tuition of $1050 *includes registration fee and covers Heart to Heart CNA Handbook, liability insurance, CNA kit (Scrubs, stethoscope, gait belt, blood pressure cuff, CPR/AED/First Aid certification): NOT INCLUDED: State Testing Fee: $98 Associated Textbook fees $Varies The tuition is guaranteed for a period of one year from the date of original publication (Jan, 2018). In addition to tuition, the student will need sneakers or nursing shoes, which may also be purchased by the student or supplied by a sponsoring agency. Students are required to provide a drug screen, background check, and evidence of screening for tuberculosis within the last 12 months at his/her expense. Total cost of supplies may vary.
Transferability of course credit disclosure*
Previous training in any health care field will not replace any material covered in this program. The CNA Training Program is a private, special purpose program. That purpose is the preparation of students to work as CNAs. This purpose does not include preparing students for further college study. Participation in the training program does not constitute a guarantee that credits will transfer to another institution. Students should be aware that transfer of credit is always the responsibility of the receiving institution. Whether or not credits transfer is solely up to the receiving institution. Any student interested in transferring credit hours should check with the receiving institution directly to determine to what extent, if any, credit hours can be transferred.
Program Data*
For the program entitled Certified Nurse Aide (CNA), I have been informed that the withdrawal rate is 0%,completion rate is 0%, and in-field placement rate is 0%. Detailed statistical data for this program may be viewed by going to and clicking “Authorized Institutions Data” button. No information is available at this time, because Heart to Heart's CNA program is a new program.
Date of withdrawal/termination will be the date on the termination notice if terminated, the date the institution receives a written withdrawal notice, or if no written notice is given, the last day of attendance. For tuition paid by student assistance programs, Heart to Heart will honor the refund policy as directed by the sponsor. For a student whose tuition is not paid through a 3rd party, the following formula will be used to determine the amount of refund: Withdrawal before first day of class, or failure to begin class Full refund less $100 administrative fee Withdrawal with 1- 10% completion 75% refund minus $100 administrative fee. Withdrawal between 11%-20% completion 50% refund minus $100 administrative fee Withdrawal at or beyond 21% completion No REFUND. A student is considered to have withdrawn when the student misses a minimum of 24 consecutive hours/ 3 days Full Time/ 6 days Part Time, class with no contact. Any student who is unable to complete class because the institution discontinued such class during a period of enrollment for which the student was charged will receive a full refund.
I realize that any grievances not resolved on the institutional level may be forwarded to: Tennessee Higher Education Commission 404 James Robertson Parkway Nashville, TN 37243-0830 615-741-5293
Authorization for Release*
I give permission to Heart to Heart and its representatives to contact previous employers, schools, agencies, and other institutions, in order to obtain information about my background. Further I give permission for Heart to Heart to perform a background check of my arrest record and to perform a drug test and TB skin test. Drug Screens may be periodically performed at random with or without advance notice. Heart to Heart has my permission to release my information, including, but not limited to grades, attendance records, background check and drug test to potential employers and to sponsoring agencies or parties. I hold Heart to Heart harmless from any liability associated with the obtaining or the release of information. I certify that all information I have given is true. I understand that providing false information is grounds for termination from this program. I have received an exact signed copy of this agreement.
By signing below, I confirm my full-time or part-time enrollment in the CNA Training Program of Heart to Heart. I agree to comply with all policies of the program, as stated in the CNA Handbook/catalog. I agree to indemnify and hold harmless Heart to Heart, its employees, agents, sponsors, and externship representatives from any and all actions, causes of action, or claims of any kind or nature during my participation in activities in the classroom, skills lab, clinical experience, externship, or other activities. I give consent for my photograph to be taken and used in promotional materials for Heart to Heart. I represent that I am in such physical condition to allow me to participate fully in all activities of the program. I agree to notify the institution of any disability I may have that falls under the American Disability Act and requires reasonable accommodations and/or assistance with evacuation in an emergency. I have reviewed and been provide a copy of the CNA Training Program course handbook/catalog and a copy of this agreement either physically and/or electronically.
By selecting Yes you agree with the content of the application*
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Heart to Heart is available for your questions!


2502 Mt. Moriah 

Suite A116

Memphis, TN 38115



Mon-Fri: 8:00am - 6:00pm
Sat: 9:00am - 1:00 pm
Sun: Closed