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.

Please note: Your first name, last name and employee ID # must match what we have on file in order to register with Education Fund.

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.