
Pre-Registration for MeritLife Academy Courses
Pre-Registration Form
Course Requirement
List of Requirements for Enrollment into the Nurse Aide Skills Course:
VALID Driver License or Gov’t issue ID ____Social Security Card ____
Immunizations:
Provide proof of the following
T DAP (within last 10 years)
MMR (Measles, Mumps, Rubella)
Hepatitis B
Varicella
Bacterial Meningitis (if under 21)
NEGATIVE TB Test (within 1 year)
Proof of Education: _____
HS, GED, ATB, Home School Certificate, or College transcript
Certificate for CBT (computer-based training) _______
Signed Release for Criminal Background Check, DADs Employability and Nurse Aide Registry
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