Nursing student holding stethoscope

Enrollment Forms

Attention CNA/HHA Students

Starting July 2017, you may be eligible to receive reimbursement up to $215 (up to $245 starting June 2018) toward your Drug Test, Physical Exam, Vaccine(s) and/or Titer Test(s), CPR Certification Fees, and CDPH (California Department of Public Health) Nurse Assistant (NA) Licensing Exam Fees after you successfully complete the CDPH NA Licensing Exam (subject to verification; original receipts are required).
The funds are provided by the Dorothy Rupe Caregiver Program at the Arthur N. Rupe foundation.
Download the REIMBURSEMENT FORM and submit to @email no later than four weeks after the state exam.

This website is under construction.

For details, go to the homepage:

Info Request Form & Info Session information are available on the homepage. Thank you!

CNA/HHA (NRS-HCA) Prospective Students
Need assistance with Enrollment Forms?

If you have already attended Orientation and/or have gotten started with Enrollment Forms, connect with the Allied Health Tutor for assistance:   Angela Flores Chacon <@email>

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

Applicant must attend the ORIENTATION [LINK] prior to application submittal.

Applicant must be able to attend all dates listed on the [WEEKLY SCHEDULE- Click HERE].

  • NOTE: Use [WEEKLY SCHEDULE] to complete CDPH 283B and 283D forms listed below.

CHECKLIST[LINK] =Click HERE to Download

  1. Applicant must be officially admitted to Los Angeles Mission College.
    • Must have valid LACCD/LAMC Student ID#.
    • Not currently LACCD/LAMC Student?
  2. Applicant must be able to log into LACCD/LAMC SIS (Student Portal) - LINK.
  3. Nurse Assistant & Home Health Aide Training Programs (NRS-HCA) Admissions Application [LINK] = Click HERE to Download
    • Download, print, and sign.
  4. Two (2) copies of American Heart Association (AHA) Cardiopulmonary Resuscitation (CPR) Basic Life Support for Health Care Providers (BLS Provider) Card (e-wallet size) valid through the duration of the program.

HEALTH RECORD [LINK] <= Click HERE to Download

  • Download, print, and bring the Health Record form to your Physical Examination, Immunization, Titer Test, Drug Test, and/or Laboratory Test Appointment(s).
    • Applicant must complete the TOP section as indicated on the Health Record pages.
  • Health Record must be completed prior to the start of the program.
    • Health Record must be 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 (provide two (2) copies of each documentation listed):
    1. Physical Examination -must be completed within 60 DAYS prior to the start of the program.
      • See: Suggested Locations below.
    2. Proof of Absence of Tuberculosis (negative)
      • skin test (within 60 DAYS prior to the start of program) -OR-
      • Quantiferon Gold TB Test (within 60 DAYS prior to the start of program) -OR-
      • chest x-ray (within 2 years prior to the start of program)
    3. Immunization Record or Titer Test Result
      • NOTE: If you have an immunization card, this will have many of the required vaccinations listed.If you are missing any vaccines, you need to receive these as applicable.
      1. Hepatitis B
        • Must have Hepatitis B at least the first shot of the three-series at the start of the program.
      2. MMR: Measles, Mumps, Rubella
      3. Polio (required by nursing homes)
        • If do not have polio vaccination, your doctor needs to clear you by writing a note such as: "childhood disease (N/A)" but not leave it blank.
      4. Tetanus (within 10 years)
      5. Varicella (Chicken pox)
      6. COVID-19 vaccinations and booster are required by healthcare facilities where clinical training takes place. Include record.
    4. 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.
    5. Flu Vaccination STRONGLY RECOMMENDED.
      • If flu vaccination is not obtained, student must:
        • submit Declination Form [LINK] = Click HERE to Download
        • and wear a mask during clinical portion of the training.
  • Suggested Locations [Physical, Drug Testing, Etc.]:

One (1) original + three (3) copies of the following(must be typed complete):

One (1) original + one (1) copy of the following(must be typed & complete):

One (1) original Live Scan form(must be typed & signed):

One (1) original + one (1) copy of the last page (Evidence of Understanding) from:

CHECKLIST [LINK] -> Review: Do you have everything?

  • If you do not yet have everything and need an extension, contact Allied Health Tutor.
    • Angela Flores Chacon, Allied Health Tutor: @email
    • Use your LACCD Student E-mail Account:
      • Click [New message]
        • To: @email
        • Subject: CNA Extension
        • Type your message regarding your situation and request for extension.
        • Click [Send]
  • If you have everything, then:
    1. Scan/take photo of paper documents,
    2. Gather all saved digital documents, and
    3. Proceed to the next step to submit documents.

If requested by Allied Health Tutor and/or CNA Program Director, submit completed documents listed above as attachments altogether on one e-mail

  • Use your LACCD Student E-mail Account:
    • Click [New message]
      • To: [You will be informed by the person contacting you where to send]
      • Subject: CNA Documents
      • Type your message.
    • On the TOP, click [Encrypt]
      • "This message is encrypted." <- Notification will appear on the top of your message window.
    • On the TOP, click [Attach] -> [Browse this computer] / [Choose from files]
    • Check that all the files are attached and the message is encrypted.
    • Click [Send]

Applicants will be notified by Allied Health Tutor if access has been granted.

After Allied Health Tutor & CNA Program Director have granted access, log into LACCD/LAMC SIS (student portal).

Valid Photo Identification & Social Security Number (for Live Scan Fingerprinting) -- BRING TO CLASS

Applicants who cannot submit documents as e-mail attachments must schedule appointment to submit hardcopy paper documents by sending an e-mail message to:  @email

After your hardcopy paper documents have been submitted, you will receive an e-mail from @email to schedule appointment with Allied Health Tutor to review your documents.

Angela Flores Chacon
Allied Health Tutor
Instructional Bldg. - 2nd floor - INST 2015

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 (NRS-HCA 399A, 056, & 399B).

NOTE: Completion of all four Health Occupations courses and 0.5 unit Allied Health 021 course is required for eligibility to petition for LAMC Certificate.

For Academic Guidance, contact *Recommended Counselors* and review [Certified Nurse Assistant & Home Health Aide] & [Health Occupations] sections of LAMC Catalog.

*Keep all your receipts to apply for reimbursement. Los Angeles Mission College was awarded a grant (starting 2017) from the Arthur Rupe Foundation to support students enrolled in the CNA/HHA Training Program.

To review the qualified expenses and apply for reimbursement please review the APPLICATION FORM.

Suggested Locations

[Physical, Drug Testing, Etc.]:

Must Have During the First Week of Class

(for Live Scan Fingerprinting) [View Weekly Schedule]

  • Valid Photo Identification & Social Security Number
    • 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.