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Jamaica Plain Community Centers

ADULT LEARNING PROGRAM

ALP Swag Store

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Home
Enroll
About
Programs
ALP Calendar
ALP Staff
Contact
Resource Center
More

Use tab to navigate through the menu items.

CNA ENROLLMENT FORM

To enroll, please complete the information below.

First Name

Last Name

Middle Name or Initial

Gender *

Male

Female

I choose not to answer

Make a Selection: *

CNA (Fall) 2024

CNA (Spring) 2025

Are you elgible to work in the US? *

Yes

No

Email

Primary Phone

Date of Birth

Secondary Phone

Place of Birth:

Address:

Street

City

State

Zip Code

Emergency Contact

Emerency Contact Name

Emergency Contact Address

Emergency Contact City & State

Emergency Contact Phone #

Emergency Contact Relationship

Do you have a Learning Disability?

If you have a disability, please describe below:

Social Security #

Select an option *

I have provided a social security number

I do not have a social security number

Public Assistance: Choose all that apply. * Required

MassHealth

SNAP (Food Stamps)

SSI

WIC

Other

None

How did you hear about ALP? * Required

Family/friend

Website

Social Media

Poster

INFORMATION

JPCC/ALP

20 South Street

Jamaica Plain, Massachusetts 02130

Information Number: (857) 728-0400

Email: info@jpadulted.org

MBTA Directions

Take the Orange Line to Green Street Station. 20 South Street is a 10 minute walk from the Orange Line at the Green Street stop.

IN PARNERSHIP WITH:

Funding Provided by:

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