Student Intake Form

Page 1

1199 Training Fund
1199 Training Fund

Thank you for enrolling in a class or program with the 1199 New England Training Fund.  To be eligible for these classes or programs you must have completed your probation period at a Connecticut nursing home that contributes to the Training Fund
1199 Training Fund
Personal Information
















For assistance regarding this form, contact Angela Alfieri, AAlfieri@1199trainingfund.org

Page 2



Nursing Home Information

















For assistance regarding this form, contact Angela Alfieri, AAlfieri@1199trainingfund.org