NURSING ASSISTANT PROGRAM REGISTRATION PACKET AND INFORMATION
HEALTH CAREERS PROGRAM
NURSING ASSISTANT PROGRAM
Classes are offered at the following locations:
Superstition Mountain Campus
Signal Peak Campus
Overview - Nursing Assistant Program
The Nursing Assistant Program is designed to prepare students to be eligible for Nursing Assistant
Certification through the Arizona State Board of Nursing and upon certification, practice in a health care
agency as a Certified Nursing Assistant and to master skills required to enter into the CAC Nursing
Program. Students may apply to the Nursing Program after successful completion of the prerequisite
courses and completing the admission requirements. The CAC Nursing Program Information and
Application Packets are available at the college admission and/or advising offices on each campus or may
be downloaded on the college website www.centralaz.edu (go to Academics – Divisions and Programs –
Applicants seeking to enroll in the Nursing Assistant course HPM 125 should read and print this packet
and complete it quickly to ensure enrollment in the class. The completed packet must be submitted to the
Health Careers Office. If you have questions or need assistance, contact the Health Careers Office at 480
677-7787 for assistance. Only applicants that have submitted completed Nursing Assistant packets to the
Health Careers Office will be allowed to register for the Nursing Assistant Classes.
Upon satisfactory completion of HPM 125 Nursing Assistant course, the student is eligible to receive a
certificate of completion. Each student must submit a request for a certificate of completion 3 weeks
prior to completing the Nursing Assistant program. It should be given to them by the instructor during
the last class.
Central Arizona College reserves the right to change without notice, any materials, information,
curriculum, requirements, and regulations in this publication.
Those wishing to register for HPM 125 Nursing Assistant Course must submit a Request for Registration
form and provide documents via My Health Tracker following the procedure described below:
1. Carefully read through the procedure for requesting registration into the Nursing Assistant course.
2. If you have questions about the process, you can contact the following contacts.
Nicole Thompson 480 677-7787
Professor Linda Buchanan-Anderson 480-677-7712
3. Complete the following information:
a. Request for Registration form
b. Documented proof of all immunizations
c. Copy of both sides of the CPR Health Care Provider Card
d. Health Care Provider Signature Form
e. ASSET or COMPASS score, Passing Reading Grade or transcript w/9 credits
f. Background Check
g. Student Checklist
SUBMIT ALL INFORMATION TO MY HEALTH TRACKER AND CERTIFIED
CertifiedBackground.com is a background check service that allows students to purchase their own
The results of a background are posted to the CertifiedBackground.com web site in a secure, tamper-proof
environment, where the student, as well as organizations can view the background check.
To order your background check from CertifiedBackground.com, please follow the instructions below.
1. Go to www.CertifiedBackgound.com and click on “Students”
2. In the Package Code Box, enter package code: CE37
3. Select a method of payment: Visa, MasterCard or Money order.
Once your order is submitted, you will receive a password via email to view the results of your
background check. The results will be available in approximately 48-72 hours.
Your package requires you to submit immunization, medical or certification records. At the end of the
order process you will be prompted to visit a secure web page where you will view additional instructions
for uploading your records.
www.Certifiedbackground.com Phone (888) 666-7788 firstname.lastname@example.org
Part 1 – Accessing your Magnus Account
Your Order Confirmation page will prompt you to visit a secure website to manage your
From the confirmation page, simply click on the link: “Login to your Magnus Account.”
You will then be re-directed to the Magnus website to set up account. To save you time, your
personal information will auto fill. You will be unable to modify this information in order for it to
match your background check results. Simply re-type your email address and enter the verification
code to continue.
After clicking “Next Step,” you will be required to log in with your user name and password.
Your User ID is the 6 digit pass code from CertifiedBackground.com
The password is sent to your email from Magnus.
Part 2 – Navigation through Magnus
Once you login, you will be brought to your Tracker Home Page. From here you can view all
trackers associated with your school/program. If more than one tracker is listed, please read the
descriptions of the trackers to make sure you select the correct one.
To view the requirements and to begin uploading records, click on the tracker name.
Note: If at any time you navigate away from your tracker, look for the Health Trackers icon
After you have selected your tracker, you can view a list of your school/program requirements.
Any record you have faxed, mailed or emailed will be located in the ”Document Properties/Details”
Part 3 – Uploading Records
You have multiple options when you need to upload records to your tracker:
Upload Document – Allows you to upload a file directly from your computer or a disk.
Fax or Mail Document – Allows you to print a cover sheet and then fax/mail your information.
To associate a new immunization record, go to “Add New Record”
Here, you can upload files directly from a disc or your computer
Once records have been uploaded, faxed, emailed or mailed, they will be associated with your
Click on “Medical Record Archive” to view all files you have uploaded and to edit information.
You can visit Magnus at any time to upload additional records at a later date:
Submit the Request for Registration form with your name on the envelope and mail or deliver to
the following address:
Health Careers Office, Room 410
Central Arizona College
273 Old West Highway
Apache Junction, AZ 85219-5321
Process for Notification of Permission for Registration
Completed requests received during registration will be dated and placed in order of receipt.
Once Request for Registration forms and documents are checked for requirements and deemed
complete by the Professor of Health Careers, the student is eligible for registration. The number of
available positions in the Nursing Assistant course is limited; students are registered only as space is
available. The student will receive permission to register by email. They must take that email
to the registrar at the college to register for the class. Once students are notified, students must
register within 1 week. Payment is due at the time of registration.
If the student fails to register within the 1 week timeframe his or her slot will be given to the next
student on the waiting list.
You may call the office 480 677-7787 to check on placement status if you have not received an email
from us by 7 days after you mailed your packet to us.
Additional Information about the Nursing Assistant Program
If you are registered for the Nursing Assistant classes and decide not to attend the program for any
reason, you must come to the Admissions office and withdraw in advance of the start date.
Any student not attending class or clinical on the first day will be withdrawn from the course. The
Nursing Assistant course has a strict attendance policy and students are expected to attend each class
The first 60 hours of class (didactic portion) will be held at the CAC (Central Arizona College)
campus. The last 90 hours of class (clinical portion) will be held in a nursing home and/or hospital
that has a contract with the Health Careers Department at CAC. Each class goes as a group to one
location at the same time. The beginning and ending times of the clinical portion may be different
than the didactic hours and will probably be 8 hour shifts; but will definitely be on the same day of
the week. For this reason, It is not usually a good idea to schedule other classes on the same day(s) as
your Nursing Assistant Class.
Nursing Assistant Uniforms: Students must wear a forest green or hunter green scrub top, white or
forest green (or hunter green) scrub pants and white shoes. You will be expected to wear your
uniform and shoes starting with the second day of class.
Books: Students may purchase course materials prior to the first day of class in campus bookstores.
The bookstore staff will tell you which textbooks and classroom materials are required for the
Nursing Assistant courses.
COST ESTIMATE FOR THE NURSING ASSISTANT PROGRAM *
HPM125* Nursing Assistant Courses (6 credits x $62.00 Arizona Resident) 372.00
Liability Insurance 25.00
Textbooks Approx. 85.00
Background check 70.00
Gait/Transfer Belt (May be required in specific agencies) Cost will Vary 12.00
Stethoscope (optional) Cost will Vary 20.00
Watch with a Second Hand Cost will Vary 10.00
Uniform and Shoes Cost will Vary 70.00
Physical Exam and Immunizations Cost will Vary 100.00
Total Estimated Cost of Nursing Assistant Program $764.00
Upon completion of HPM 125 students are eligible to take the examination for certification as
Nursing Assistants administered under the guidelines of the Arizona State Board of Nursing.
The cost for obtaining certification is approximately $85.00. Contact the ASBON at
http://www.nursing.state.az.us/ or 602-889-5150.
*Fees are subject to change by the Central Arizona Community Colleges Governing Board. All
costs quoted are subject to change.
REQUIRED DOCUMENTATION INFORMATION
Required Immunizations Documentation is as follows:
Documentation of 2 MMR (Measles/Rubella, Mumps & Rubella) vaccinations, if done under
the age of 18 or documentation of 1or 2 MMR vaccinations if done after the age of 18
Documentation of 2 Varicella (Chickenpox) vaccinations.
Documentation of 1 Tetanus/Diphtheria (Td) immunization within the past 10 years.
Documentation of 1 Tuberculosis skin test (PPD) and the results within the past 6 months.
If skin test is positive, documentation of a chest x-ray negative for evidence of
disease within the past 6 months is required.
Documentation of 3 Hepatitis B vaccinations.
Documentation of the first vaccination must be submitted with the packet;
documentation of the second one must be submitted one month after the first
vaccination and the third one 4 months after the second vaccination.
If you are immune because you had one of the above diseases, documentation of a positive
Titer Test result may be substituted for documentation of a vaccination. In the case of the
MMR, you would need to submit positive titer results for all 3 diseases. If the Titer Test is
negative, you will need to have the vaccination.
Students are responsible for maintaining their own health records including current CPR certification and
proof of negative TB skin tests until completion of the program. Copies of proof of these updates must be
submitted to the Health Careers Department when due.
Some places that offer immunizations would be your private physician, the Pinal County Health
Department, the Maricopa County Health Department and EVVAX (East Valley Vaccination and
Examination Center in Mesa. Your private physician and EVVAX may offer Titer tests.
Students are responsible for their medical expenses.
You must take a HEALTH CARE PROVIDER CPR Class CPR certification must include infant,
child, and adult, 1 and 2 man rescuer, and evidence of a land-based demonstration component. CPR
certification must have been completed within the last 12 months. Include a copy of both sides of the
CPR card in your Nursing Assistant Packet. You must take the CPR class in person; online class
certification is not acceptable.
CPR class dates and locations are available online. Some of the organizations that offer these are CPR
instruction.com; American Safety & Health Institute; The Heart Association, local fire departments and
the first week of the semester at the CAC campus.
HEALTH CARE PROVIDER SIGNATURE FORM
A health care provider must sign Health Care Provider Signature Form (page 8 of this packet) and
indicate whether the applicant will be able to function as a Nursing Assistant student. Health care
providers who qualify to sign this declaration include a licensed physician (M.D., D.O.), a nurse
practitioner or physician’s assistant.
If any medical condition exists which may interfere with your becoming a NA, then you may be sent to an
independent practitioner. (The student is responsible)
HEALTH DECLARATION: It is essential that nursing students be able to perform a number of
physical activities in the clinical portion of the program. At a minimum, students will be required to lift
patients, stand for several hours at a time and perform bending activities. Students who have a chronic
illness or condition must be maintained on current treatment and be able to implement direct patient care.
The clinical nursing experience also places students under considerable mental and emotional stress as
they undertake responsibilities and duties impacting patients’ lives. Students must be able to demonstrate
rational and appropriate behavior under stressful conditions. Individuals should give careful
consideration to the mental and physical demands of the program prior to making application.
ASSET OR COMPASS READING TEST
Obtain a copy of the ASSET or COMPASS Reading Test from the Registrar at the college where you
took the test. If your score was less than 41 on the ASSET Reading test or 81 on the COMPASS Reading
Test, you will need to take and pass Reading 094 prior to enrolling in the Nursing Assistant Class.
If you have completed 9 or more transferrable credits at another college, you will need to have those
credits transferred by having an official transcript sent to Central Arizona College and including an
unofficial transcript showing these credits with your Nursing Assistant Packet.
All students registered for the Nursing Assistant course will be responsible for obtaining a background
check from CertifiedBackground. The website address is www.CertifiedBackground.com
WAIVER OF LICENSURE/CERTIFICATION GUARANTEE: Admission or graduation from the
CAC Nursing Program does not guarantee obtaining a license or certificate to practice nursing. Licensure
and certification requirements and the subsequent procedures are the exclusive right and responsibility of
the Arizona State Board of Nursing. Students must satisfy the requirements of the Nurse Practice Act:
Statutes, Rules and Regulations, independently of any college or school requirements for graduation.
Pursuant to A.R.S. § 32-1606(B)(17), an applicant for professional or practical nurse license by
examination is not eligible for licensure if the applicant has any felony convictions and has not
received an absolute discharge from the sentences for all felony convictions. The absolute discharge
must be received five or more years before submitting this application. If you cannot prove that the
absolute discharge date is five or more years, the Board cannot consider your application.
After finishing the Nurse Assistant program, as a part of the certification process, all nursing assistant
applicants for certification and licensure must be fingerprinted to permit the Department of Public
Safety to obtain state and federal criminal history information. All applicants with a positive history are
investigated. If there is any question about eligibility for licensure or certification, contact the nursing
education consultant at the Arizona State Board of Nursing (602-889-5150).
REQUEST FOR REGISTRATION
(PRINT) Name _________________________________________Student ID Number______________________
(PRINT) E-Mail Address (will be used to notify you of your acceptance) __________________________________
Phone: Cell ________________________Day________________________ Evening _____________________
Mailing Address _______________________________________________________________________________
COURSE ID: HPM125 NURSING ASSISTANT
I am requesting (Check one): ____ Signal Peak Campus in Coolidge
____ Superstition Mountain Campus in Apache Junction
____ Aravaipa Campus
1st Choice CRN #_______________
2nd Choice CRN #_______________
Health Care Provider Signature Form
Applicant Name_______________________________ Student ID Number_________________
It is essential that Nursing Assistant students be able to perform a number of physical activities
in the clinical portion of the program. At a minimum, students will be required to lift patients,
stand for several hours at a time and perform bending activities. Students who have a chronic
illness or condition must be maintained on current treatment and be able to implement direct
patient care. The clinical nursing experience also places students under considerable mental and
emotional stress as they undertake responsibilities and duties impacting patients’ lives. Students
must be able to demonstrate rational and appropriate behavior under stressful conditions.
Individuals should give careful consideration to the mental and physical demands of the program
prior to making application.
I believe the applicant _______ WILL OR _______ WILL NOT be able to function as a
nursing student as described above.
If not, explain: _____________________________________________________________________________
Licensed Healthcare Examiner (M.D., D.O., N.P., P.A.)
Print Name: _______________________________________________ Title: ___________________________
Signature: __________________________________________________ Date: ___________________________
City: __________________________________________ State: ____________________ Zip: ___________
TO DETERMINE COMPLETENESS OF
NURSING ASSISTANT PACKET
(PRINT) Name _____________________________________Student ID Number___________________
(PRINT) E-Mail Address (will be used to notify you of your acceptance) ______________________________
The following items have been enclosed in this packet:
All immunization records must include:
your name Nurse Assisting rev. 9/15/08
signature of the healthcare provider giving the immunization
date of immunization
_____ Documented proof of MMR (Measles/Rubeola, Mumps, Rubella) vaccinations or 3 positive titer tests.
_____ Documented proof of Varicella (Chickenpox) vaccination or positive titer test.
_____ Documented proof of a Tetanus/Diphtheria (Td) immunization within the past 10 years.
_____ Documented proof of a TB skin test (PPD) and negative results within the last 6 months
or documented proof of a tuberculosis-free status on an x-ray within the last 6 months.
_____ Documented proof of 3 Hepatitis B vaccinations or positive titer test.
Documentation of the first vaccination must be submitted with the packet;
documentation of the second one must be submitted one month after the first vaccination
and the third one 4 months after the second vaccination.
_____ Documented proof of CPR Health Care Provider Certification within the last 12 months.
A copy of both sides of the CPR certification card.
_____ Health Care Provider Signature Form signed by Physician or Physician’s Assistant or a Nurse Practitioner
_____ Placement Scoring showing a passing score of 41 on the ASSET or 81 on the COMPASS Reading Test
or documented proof of a passing grade in Reading 094
or documented proof of an Official Transcript sent to CAC with 9 or more transferrable credits.