Workforce Nursing & Allied Health Application

Workforce Nursing & Allied Health Application
Program Applying for:*

Train the TrainerCertified Nursing Assistant (CNA)Electrocardiograph Technician (ECG)Medical AssistantSterile Processing RefresherPhlebotomy Refresher
Have you taken the TABE?

YesNo
What was your TABE Score? (Enter number 1-10)
Please submit your TABE test results.*

Cancelof
You must have taken the TABE and score at least a NRS 4 or higher to continue with the application. Please contact Mrs. Eve Anderson for remediation at Eve.Anderson@fletcher.edu or 985-448-5926.
Which semester are you applying for?*

FallSpringSummer
When would you prefer your labs?*

DayEvening
Are you currently enrolled in an Adult Education Program at Fletcher or Bayou Cane Adult Ed?*

YesNo
Name*

First NameLast Name
Please list all previous names/aliases*
Type N/A if not applicable
Fletcher Student ID (LoLA Number):*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number (cell)*
Please enter a valid phone number.
Email*
example@example.com
Birth date*

MonthDayYear
Date
Applicants must possess a high school diploma or equivalency to apply to this program. Please input date high school diploma or equivalency was awarded*
Ex. 05/1996
Are you presently a student at Fletcher?*

YesNo
Are you a LCTCS employee?*

YesNo
Are you currently employed as a Sterile Processing Technician?*

YesNo
Are you currently employed as a Phlebotomist?*

YesNo
If yes, where are you employed?*
If no, have you met the required 400 hours of experiencing in an SPD in the last 5 years?*

YesNo
Have you met one of the following requirements below?*

1 year of supervised work experience in a phlebotomy technician field within the last 3 years (this work experience must include successfully performing a minimum of 30 venipuncture and 10 capillary sticks on live individuals)2 years of supervised work experience in a phlebotomy technician field within the last 5 years (this work experience must include successfully performing a minimum of 30 venipuncture and 10 capillary sticks on live individuals)
Calculation
Background Checks:

Background checks are required for the following programs:
- Nurse Assistant
- Medical Assistant
- Electrocardiograph Technician (ECG)
Click here to submit your background check.

Instructions:
- Click here for Instructions
I acknowledge my application is not completed and cannot be considered for admission into the program until my background check is received.
I understand that once I am registered for the class/program, I will be responsible for tuition and fees assessed. I also understand that tuition and fees for these classes/programs are nonrefundable unless the college cancels the class/program.
If I receive funding from an outside source and that funding is discontinued before the full amount is paid, I understand that I am responsible for paying the remaining balance. Additionally, I acknowledge that if I withdraw from, am dismissed from, or am unsuccessful in the class/program, my eligibility for continued outside funding may be affected, and I will be responsible for paying any remaining balance.

Should be Empty:

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