Kentucky Health Care Training Institute
3010 Taylor Springs Drive
Louisville, KY 40220
Phone 502-458-4570
Fax 502-458-4240
The next available class is 11/20/2024 - 4/10/2025. The class meets each Wednesday. The class times are 8:00 a.m. to 1:00 p.m.
Enclosed is an application form for the class. If you are interested in the class, please call 502-458-4570 to set an appointment to enroll.
YOU MUST HAVE THE FOLLOWING WITH YOU AT TIME OF ENROLLMENT:
Kentucky Health Care Training Institute does not discriminate in employment or enrollment on the grounds of race, gender, color, age, national origin, sexual orientation, or disability.
Refund Policy - If a student cancels the class by 3:00 the Thursday before the class begins, $125.00 will be refunded. If the student does not cancel by 3:00 the Thursday before the class begins, the $50 no show fee will be deducted from the $125.00 refund. Once the student has attended any part of the class, there will be no refund.
There is an attendance policy in this class. If a student misses more than 6 hours, the student will be dropped from the class. The student must also maintain a 70% grade point average to complete the course. Class must be attended on the first day or the student will not be registered in that course.
Kentucky Health Care Training Institute
Name _____________________________________________________
Mailing Address ___________________________________________________
City, State, Zip Code _______________________________________________
Telephone Number _____________ SSN __________________________
Is the documentation verifying high school diploma or GED included with the application?
YES _________ NO ____________
Is CURRENT documentation verifying status on the Kentucky Nurse Aide Registry included with the application?
YES ____________ NO ____________
Is proof of professional liability insurance included with the application?
YES _______ NO ________
Has above applicant been employed as a nurse aide in long-term care for at least 6 months in the last 2 years?
YES _____________ NO __________________
THIS MUST BE SIGNED BY A REPRESENTATIVE OF A FACILITY IN WHICH THE APPLICANT HAS WORKED FOR 6 MONTHS AS A NURSE AIDE IN THE LAST 2 YEARS.
_____________________________________ ____________
Signature and title of facility representative Date
PLEASE NOTE- ALL SPACES MUST BE COMPLETED. ANY QUESTIONS THAT HAVE BEEN ANSWERED ?NO? WILL RESULT IN THE APPLICATION BEING REJECTED.
Refund Policy- If a student cancels the class by 3:00 the Thursday before the class begins, $125 will be refunded. If the student does not cancel by 3:00 the Thursday before the class begins, the $50 no show fee will be deducted from the refund. Once the student has attended any part of the class, there will be no refund.
A student in the program is not allowed to miss more than 6 hours of class. If any more than 6 hours of class is missed, the student will be dropped from the course. The student may not miss any clinical hours. A grade point average of 70% and a grade of 70% on the final exam are required in order to complete the course.
I certify that the information on this application is correct and complete to the best of my knowledge. I also understand the grade and attendance policy for this program and the refund policy as outlined above. I understand that I must be in uniform each day of the class.
______________________________________ _____________
Signature of Applicant Date