Long Term Care Training Request

Request For Pre-Training Enrollment

Step 1: This form must be completed and submitted. Upon receipt of your request, you will be required to complete the application for admission, sign and mail with your course payment.

Step 2: Once admission form is completed, signed and check is received, the course will be opened for your participation.

Step 3: Prior to receiving your certificate you will need to complete a transcript, sign and mail.

Mail completed admission form, tuiition payment and transcripts to:

Community Resource Associates Training
1943 S. College
Tulsa, OK 74104

Health Care Administrator Certification for Residential Living Facilities

Please enroll me in the Health Care Administrator Certification for Residential Living Facilities.

Is this the course for you?Enroll in the Health Care Administrator Certification for Residential Living Facilities if you are:

• A current employee of a licensed residential care living facility
• An aspiring health care employee who desires to advance into residential care facilities administration
• An individual who may soon be promoted to a residential care facilities administrator

Health Care Administrator Re-Certification for Residential Living Facilities

Please enroll me in the Health Care Administrator Re-Certification for Residential Living Facilities

Is this the course for you?Enroll in the Health Care Administrator Re-Certification for Residential Living Facilities if you are:

• A licensed residential care administrator
• An individual from other programs approved by the Office of Long Term Care

Health Care Administrator Certification for Assisted Living I & II Facilities

Please enroll me in the Health Care Administrator Certification for Assisted Living I & II Facilities

Is this is the course for you?Enroll in the Health Care Administrator Certification for Assisted Living I & II Facilities if you are:

• A current owner/employee of an assisted living I and II facility
• Any developing assisted living facility personnel
• An individual who desires to upgrade their occupational qualifications

Health Care Administrator Re-Certification for Assisted Living I & II Facilities

Please enroll me in the Health Care Administrator Re-Certification for Assisted Living I & II Facilities

Is this is the course for you?Enroll in the Health Care Administrator Re-Certification for Assisted Living I & II Facilities if you are:

• A licensed assisted living I and II facility adminstrator
• An individual from other programs approved by the Office of Long Term Care

Your Information

Name:

Address:

City:

State:

Zip:

Office Phone:

Facility:

Home Phone:

E-mail:

Desired Class Setting

On-line training

Live training

Correspondence training