Become A Nurse Aide (NA) register at halo institute Name * First Name Last Name Date Of Birth MM DD YYYY Age Gender Female Male Race White Black Hispanic Asian Highest Level Of Education High School Diploma GED Some High School Some College Physical Address Address 1 Address 2 City State/Province Zip/Postal Code Country Scrub Uniform Size Select Size XS S M L XL 2XL Phone (###) ### #### Email * Signature Thank you for your interest in Halo Institute!A member of our team will be reaching out to you shortly. We look forward to connecting with you!Warm regards,The Halo Institute Team