Main Content for Tab Navigation.

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 no later than four weeks after the state exam.

CNA/HHA (NRS-HCA) Summer & Fall 2022 Prospective Students
Need assistance with Enrollment Forms?
If you have already attended Orientation and/or have gotten started with Enrollment Forms, connect with the CNA Tutor for assistance on:

2nd Floor of Instructional Building
(INST) - Room # 2016
Main Campus
13356 Eldridge Avenue, Sylmar, CA 91342

Question about CNA Tutor assistance sessions?

*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.

  • If you missed the Orientation, contact *on E-MAIL*:

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 CNA Program Director.
  • 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.

Submit completed documents listed above as attachments altogether on one e-mail to:

  • Aracely Molina, CNA Program Director:
  • Use your LACCD Student E-mail Account:
    • Click [New 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 CNA Program Director if access has been granted.

After CNA Program Director has 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:

After your hardcopy paper documents have been submitted, you will receive an e-mail from to schedule appointment with CNA Program Director to review your documents.

Aracely Molina
CNA Program Director
(Google Number: 818-714-1448)
Instructional Bldg. - Faculty Office #13 (1st floor)

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.

Contact Us


Allied Health Office
Instructional Center (INST) 2015

Phone: (818) 833-3428 (Voicemail ONLY. Please send an e-mail.)

Instructional Bldg. Room 2015

Crescentia Muljawan
Senior Office Assistant
Phone: (818) 833-3428

Instructional Bldg. -Faculty Office #13 (1st floor)

Aracely Molina
CNA Program Director
Phone: (818) 833-3436
(Google Number: (818) 714-1448)

Center for Math & Sciences -CMS 221 (Rm. 238)

Par Mohammadian, RPh, PhD
Vice Chair of Life Sciences Department
Phone: (818) 833-3424

Center for Math & Sciences - CMS 227

Dr. Stephen T. Brown
Chair of Life Sciences Department
Phone: (818) 364-7665

Info Request Form<CLICK HERE>
Biotechnology Info<CLICK HERE>