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Allied Health

Allied Health : Nurse Assistant & Home Health Aide : Enrollment Forms

Enrollment Forms

Attention CNA/HHA Students

Starting July 2017, you may be eligible to receive reimbursement up to $215 toward your drug testing, malpractice insurance, certification exam, and CPR card fees after you successfully complete the California Department of Public Health (CDPH) examination (subject to verification; receipts are required). The funds are provided by the Dorothy Rupe Caregiver Program at the Arthur N. Rupe foundation. Please download the REIMBURSEMENT FORM [click here to download] and submit to our office no later than four weeks after the state exam.

*Required Documents to Enroll in Nursing 399AB+056:     
[Enrollment is first-come, first-served!]

  1. Must be officially admitted to Los Angeles Mission College. Must have valid LACCD/LAMC Student ID#.
  2. Must be able to log into LACCD/LAMC SIS (student portal). Click [Register For Classes] icon above and log in.
  3. Applicant must be able to attend all dates listed on the [WEEKLY SCHEDULE].
  4. STRONG RECOMMENDATION:  Applicant to attend the MANDATORY ORIENTATION prior to application submittal. If you miss the MANDATORY ORIENTATION, <= click to see details.
  5. Must submit the NATP-HHP Application:
  6. Health Record portion of the application (see #6, above) must be completed within 60 DAYS prior to the start of the program and signed by a Physician, Nurse Practitioner, or Physician Assistant, specifying that you can participate in the classroom and clinical internship portions of the program without any limitations. Health Record must include the following: 
    • Physical Examination - must be completed within 60 DAYS prior to the start of the program. See Suggested Locations below.
    • Proof of Absence of Tuberculosis - negative skin test (within 60 DAYS prior to the start of program) -OR- negative chest x-ray (within 2 years prior to the start of program)
    • Immunization Record or Titer Test Result of:
      • Hepatitis B
      • MMR:  • Measles,  • Mumps,  • Rubella 
      • Polio (required by nursing homes)
      • Tetanus (within 10 years) 
      • Varicella (Chicken pox)
    • Drug Screen Test Results (urine drug screen test, 8 panels, negative result per panel, within 60 DAYS prior to the start of program)Lab Results must be included. See Suggested Locations below.
    • Flu Vaccination STRONGLY RECOMMENDED.  If flu vaccination is not obtained, student must submit Declination Form and wear a mask during clinical portion of the training.
  7. Malpractice Insurance application with policies listed (District requires $1,000,000 single occurrence & $3,000,000 Aggregate)
  8. Cardiopulmonary Resuscitation (CPR)  American Heart Association Basic Life Support for Health Care Providers (BLS Provider) Card valid through the duration of the program. Please do one of the following:
  9. Strong Recommendation:  Completion of all four Health Occupations courses (HlthOcc 062, 063, 064, & 065) is strongly recommended but not required for eligibility to enroll and participate in Nurse Assistant & Home Health Aide courses (Nursing 399A, 056, & 399B).
  10. ​​​When you have completed Steps #1-9 above, send an e-mail to <alliedhealth@lamission.eduand request to schedule appointment for CNA-HHA Application Review.
*Keep all your receipts to apply for reimbursement. Los Angeles Mission College was awarded a grant (2017/2018) from the Arthur Rupe Foundation to support students enrolled in the CNA program. To review the qualified expenses and apply for reimbursement please review the APPLICATION FORM =>If you have all the required documents and would like to apply for reimbursement, please send an e-mail to <> with "Arthur Rupe" in the subject line and let us know when you would be available to submit your completed Arthur Rupe Reimbursement Application Form and the supporting documentation required.

Suggested Locations:

Must Bring to First & Second Days of Class:          [View Weekly Schedule]

  1. CDPH CNA application form (283B)     [Summer 2019]     and   
  2. CDPH HHA application form (283D)    [Summer 2019]      and
  3. Live Scan application form -CLICK HERE-  Please type your information!  ->Click here for instructions<-
  4. Valid photo identification
    • Acceptable Photo IDs: Valid Non-Expired state or federal (e.g. driver's license, ID card, passport with photo (any country), alien registration (green card), or military ID). 
    • Social Security Number. Note: Students with no social security number may contact CDPH Aide and Technician Certification Section at (916) 327-2445 for specific information.
**For CNA resources from CDPH, [click here].  For HHA resources from CDPH, [click here].**


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If you have an urgent message, please send an e-mail to

Office Hours
Monday - Friday :: BY APPOINTMENT ONLY.   
E-mail to request an appointment.
-> Info request RSVP link:

Instructional Center (INST) 2015

818-833-3428 (If we miss your call, please send an e-mail so we may be able to contact you sooner.)

Crescentia Muljawan
Senior Office Assistant
Instructional Bldg. Room 2015

Patricia Velazquez
Program Assistant
Instructional Bldg. Room 2015

Ashley Mendoza
Biotech Career Guidance Counselor Assistant
Center for Math & Sciences - CMS 221

Par Mohammadian, RPh, PhD
Associate Professor, Vice Chair of Life Sciences - Director, Allied Health Programs - 818 833-3424
Center for Math & Sciences - CMS 221 (Rm. 238)