NHCLC Testing Registration - Lincoln - Nebraska Health Care Association

Date
Date Format: MM slash DD slash YYYY
Unique ID
Event Description*
Class Code*
Location Code*
Early Cutoff*
Date Format: MM slash DD slash YYYY
The testing registration deadline has now past.
Please select another testing location or date.
Testing Fee - (Non-refundable)*
- Medication Aide Written Testing - $35.00
- Basic Nursing Assistant Written Testing - $35.00
- Basic Nursing Assistant Clinical Testing - $40.00
- Basic Nursing Assistant Written & Clinical Testing - $75.00
Total
$0.00
NA Testing Additional Information
Do you have a lapsed Basic Nursing Assistant License?*
- Yes
- No
Lapsed License Number*
If you don’t know your License number, type Unknown.
Where did you take your NA Class?*
Who was your instructor?*
When did you complete your training?*
Do you require the test read aloud?
- Yes
- No

Social Security Number*
SSN Hidden*
A student’s Social Security number is required as a condition of enrollment. A student’s Social Security number constitutes an “educational record” under the Federal Educational Rights and Privacy Act (FERPA). That information will be disclosed only with the consent of the student or in those very limited circumstances when consent is not required by FERPA.
Name*
First Last
Maiden Name
Home Address*
Street Address Address Line 2 City State ZIP Code
County*
Phone (Day)*
Phone (Evening)
E-mail Address
This is how we will send you information, so while not required, it is highly recommended!
Date of Birth*
Date Format: MM slash DD slash YYYY
Do you authorize NHCLC to send testing results to the provided email?*
- Yes
- No
Email Address*
Release of Information*
In compliance with the Family Educational Rights and Privacy Act of 1974 (FERPA), a student must complete an information release form to authorize the Post-Secondary Career School (NHCLC) to release information to designated person(s). Student information will not be shared with third parties except:

• As necessary to meet one of its lawful purposes, including but not limited to:
o Contact compliance
o Consent provided by you, and/or
o As required by law.

The Nebraska Health Care Learning Center (NHCLC) may send education records by mail to the student’s designated address. Students requesting education records electronically must authorize the release of that information.

This consent to release information can be completed, amended, or revoked at any time.
- I agree to the Terms of Service

Terms of Service*
WE ARE UNABLE TO BILL. WE ARE UNABLE TO REFUND. NON-ATTENDANCE AT TESTING IS AN AUTOMATIC FORFEITURE OF FUNDS.

PAYMENT FOR TUITION MUST BE INCLUDED WITH THIS REGISTRATION FORM. PAYMENT MUST BE RECEIVED SEVEN (7) BUSINESS DAYS BEFORE THE TESTING DATE IN ORDER TO BE REGISTERED.

AN EMAIL WILL BE SENT THE WEEK OF TESTING OUTLINING SPECIFIC INFORMATION, I.E., TIME OF TESTING, LOCATION, ETC. PLEASE CHECK YOUR JUNK MAIL IF YOU DO NOT RECEIVE IT.
- I agree to the Terms of Service
Do you have a Scholarship or Coupon code?
- Yes
Coupon*
Copy Credit Cardholder Address from Home Address?
This address must match the Credit Card billing address.
- Yes
Cardholder Address*
Street Address Address Line 2 City State ZIP Code
Cardholder's Email*
Cardholder Name*
Total amount to be charged to Credit Card
$0.00
Credit Card

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name

Review Your Selections
Click "Previous" to make changes. Click "Submit" to process your registration(s). {all_fields:exclude[67]}

Step 1 of 4 - Basic Information

The testing registration deadline has now past.

NA Testing Additional Information

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