Nursing Assistant (CNA) | Pre-Application Instructions

FVTC's Nursing Assistant program is approved by the Wisconsin Department of Health Services. In order to complete the course you need to participate in a clinical experience.  All clinical agencies require completion of a background check and specific health requirements. This information needs to be sent to the agency prior to the class starting. 

To make it easier to fulfill these requirements, we've grouped them into two steps.

Step 1 | Pre-Application & Background Check Forms

Step 1A: Pre-Application Form:

  • General Information
  • Technical Standards Statement 
  • $75 Payment for Pre-Application Process and E*Value access. (Unless you have a sponsor code which you'll be asked to provide.)

Pre-Application Form

Step 1B: Background Check Information Form: 

  • Information/Form for FVTC to order a Background Check on your behalf will be sent to your email after completing Step 1A.  Please complete the Background Check Information Form within 24 hours to avoid background check order delays.

Step 2 | COmplete & Upload Health Information

After Steps 1A & 1B are complete:

  • Check your email. In 3-4 business days you will be emailed your E*Value access and instructions for uploading your health requirements documents. 

Print, complete, scan & upload these forms:

  • TB Testing (2 step) 4 visits (PDF)
  • Annual Influenza (required if class dates are from 11/1 through 3/31 or enrolling during this time) Please note: Clinical sites have the right to require annual influenza vaccination past this timeframe.


  • STEP 1A: Payment (or sponsor code) is needed to submit the form. PayPal/Credit Card is the only accepted form of payment. The $75 pre-application fee is non-refundable.
  • STEP 1B: Your Social Security number is required to complete your background check.
    If your background report includes prior charges, the information will be reviewed by a clinical site prior to your application advancing to class registration. 
  • STEP 2: Some of these tests and immunizations require more than one visit.
    It may take up to 6 weeks to complete the health work needed to go to clinical so starting those as soon as possible is a good idea. Specific dates and provider verified proof is needed to complete these forms.

All pre-application background check and health requirements must be complete in E*Value before you can be admitted into the Nursing Assistant program and register for any Nursing Assistant class.