RCC NA Applications

NA Training Application - Rogue Community College (Table Rock Campus)

Long-Term CareWorks offers a no-cost, sponsored nursing assistant (NA) training program through Rogue Community College. This program provides expert instruction, mentorship, and meaningful financial support on your path to employment in long-term care.
Contact and Demographic Information
Legal Name*

First NameMiddle NameLast NameSuffix
Date of Birth*

MonthDayYear
Date
Social Security Number*
We use this for the background check. A valid SSN is required to take the CNA exam in Oregon. If you don't have one, please reach out to us.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What county do you live in?*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Are you a current or former homecare worker, personal support worker, or personal care attendant?*

homecare workerpersonal support workerpersonal care attendantNo
How did you hear about this program?*
I understand that the goal of this program is for me to work as a CNA in one of our partnered, unionized long-term care facilities after completing my training and receiving OSBN certification.
Do you plan on moving within the next year?*

YesNo

Minimum Requirements to participate

Each applicant must meet the minimum requirements of RCC's training program to be considered as a candidate.
Are you at least 18 years or older?*

YesNo
Do you have a valid government-issued form of identification from the United States?*

YesNo
Are you able to pass a Urinalysis (UA) drug screen?*

YesNo
Attendance Requirements
This is a fast-paced program. Due to this short timeline, there will be no makeup days available. This means you may not miss any portion of class for the duration of the program.

Students are responsible for attending in-person classes, labs, and clinicals from Wednesday, Febraury 18 through Friday, March 27.

Dates and times for clinicals are assigned once students are enrolled and the schedule is finalized.

If you have any prior commitments during this time frame that you aren't able to miss, we ask that you keep this program in mind to join at a later date.

Please note: Program schedule is subject to change
Are you able to attend all class dates listed above?*

YesNo

CNA Duties and Responsibilities
Are you comfortable working in an environment that may contain infectious diseases?*

YesNo
Are you comfortable working around bodily fluids? CNAs often work with blood, urine, feces, etc.*

YesNo
Facilities generally schedule CNAs on a 4 on, 2 off rotation. This means you could work Mon-Thu and have Fri-Sat off one week, then work Sun-Wed and have Thurs-Fri off the next week.
Does the example schedule outlined above work for you?*

YesNo
If you are hired at a partner-facility, which of the following times would you be able to work? Select all that apply. Please note that the facilities can't guarantee that you'll receive your preferred shift.*

6am-2pm2-10pm10pm-6am

Wraparound Support needs assessment

Long-Term CareWorks is committed to identifying and addressing obstacles that make it challenging for learners to finish and excel in our CNA training programs. The following questions will help us understand how we can better serve you if you're chosen to participate in our program.
Are there any obstacles that might make it difficult for you to fully participate in CNA training and job placement? If so, please list below. Obstacles may include reliable transportation, secure housing, food access, childcare, etc.*
Do you have access to school supplies such as pens/pencils, notebooks, note cards, etc.?*

YesNo
A requirement of participating in this program is showing up, in-person, at various locations in Medford and the surrounding area. Do you have reliable transportation to attend classroom and clinical locations at sites that may not have public transit access?*

YesNo
If applicable, do you have reliable childcare?

YesNoNot applicable
Long-Term CareWorks offers other needs-based wraparound supports so students experiencing barriers can complete the program. Would you be interested in learning more about these supports?*

YesNo
Form Title
Location
Application Type
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NA Training Application - Rogue Community College (Table Rock Campus)