Care With Passion Training Program

Student Application

Complete this application to create your student account. After you submit, admissions will review it within 24–48 hours.

Personal Information

Full Legal Name * Date of Birth * Home Address * City * State * ZIP Code * Cell Phone * Alternate Phone Email Address * Emergency Contact Name * Emergency Contact Relationship * Emergency Contact Phone *

Student Account

Create a username and password for the student portal, the same way you would on My account.

Username * Letters and numbers. No spaces. Password * At least 8 characters.

Your personal data will be used to support your experience throughout this website and to manage access to your account.

Eligibility Verification

Are you 18 years of age or older? *

Yes No

Government-Issued Photo ID * JPG, PNG, or PDF. Max 8 MB.

Are you legally authorized to work in the United States? *

Yes No

Prior Healthcare Training *

Yes No

If yes, list certifications *

Program Selection

Program Selection * Preferred Start Date * Preferred Skills Lab Schedule * How did you hear about us? * If Other, please specify *

Background & Health Requirements

Additional NJ BON Fees (Paid Directly to the State)

Background Check & Fingerprinting: $80

The $80 NJ Board of Nursing background check fee is separate from tuition and must be paid directly to IdentoGO. Care With Passion Training Program does not collect this fee.

I understand a criminal background check is required for certification. * TB Test / Health Clearance JPG, PNG, or PDF. Max 8 MB.

Physical Limitations *

Yes No

If yes, explain *

Financial Agreement

Payment Method *

Non-Refundable Registration Fee Only

$299 due at enrollment

This secures your seat. Remaining balance must be paid before Module 4.

Pay in Full

$599 total

Pay the full tuition at enrollment.

Payment Plan

Total Remaining Balance: $300

Payment schedule:

$150 – Week 1

$150 – Week 2

Registration fee of $299 is required upfront.

I understand all fees are non-refundable once coursework begins. *

Required Documents

Upload remaining documents if you have them now. Government-issued photo ID is uploaded under Eligibility Verification. JPG, PNG, or PDF. Max 8 MB each.

Social Security Card Background Check Consent Form High School Diploma or GED (recommended)

Signatures

Student Signature *

Signature Date *

Admissions staff signature is collected internally and is not part of this form.