Welcome Education Fund Participants

Please complete the form below. After submission, you will receive a temporary password which you can use to log in to the system & take
as many classes as you’d like.

Please note: You are registering through Education Fund. You do NOT have to make a payment on cnaZone.com.
If at any time you are prompted for payment please write us by clicking here.

All the fields are required

First Name

Last Name

Address

City

State

Zip

Date of Birth (MM/DD/YYYY)

Cell Phone (Enter in this format: 555-555-5555)

Home Phone (Enter in this format: 555-555-5555)

Employee ID #

Date of Hire (MM/DD/YYYY)

Region

Employer (Select a region first)

Facility (Select an employer first)

Union Representation

Union not in list? Other:

Ethnicity (optional)

Job Classification

License Type

License Number

License expiration date

I certify that all of the information on this form is true and complete to the best of my knowledge. If asked, I agree to provide substantiation of the information I have given on this form. I agree that the Education Fund may share my name and contact information with my employer and the training institution in order to verify my eligiblity and enrollment status. I undestand that the specific information related to my academic performance will not be shared with my employer. I agree that the Education Fund may contact me via text message or email. Message and data rates may apply.