CNA Schools in Santa Cruz, CA: Compare Programs, Costs, and Schedules

Find CDPH-approved CNA training in Santa Cruz, compare tuition, schedules, and start dates.

By Aslam MultaniReviewed by Editorial staffUpdated September 16, 202624 min read
CNA Schools in Santa Cruz, CA | Programs & Costs

Key Points

  • Gavilan College is the only campus within realistic commuting distance.
  • Santa Cruz CNA pay runs above the California statewide median.
  • California requires in-person clinical rotations, even for online CNA programs.

Local classroom seats versus a short drive south: that is the real choice facing Santa Cruz County residents pursuing a nursing assistant certificate. Santa Cruz County has no CDPH-approved classroom program of its own, yet demand for certified nursing assistants across hospitals, skilled nursing facilities, and home care agencies keeps climbing as the region's population ages.

Training remains one of the fastest, most affordable entry points into healthcare, with total program costs ranging from under $1,000 at community college sites to over $3,000 at private schools offering flexible online coursework paired with local clinical placements.

That cost spread, combined with limited in-county seats, makes program selection the deciding factor for how quickly you get certified.

See the top CNA programs for Santa Cruz students →

Santa Cruz CNA Landscape: Where CNAs Work and Local Demand

CNA work in Santa Cruz County means providing hands-on patient care in hospitals, skilled nursing facilities, and home or community settings. The setting you choose shapes your typical shift, clinical training options, and your CNA job timeline after certification.

Major healthcare employers in the Santa Cruz area

  • Hospitals: Dominican Hospital in Santa Cruz is the largest local hospital employer. Hospital CNA or patient care technician roles usually require a CNA credential, BLS, and often EKG or finger-stick skills.
  • Skilled nursing and post-acute facilities: Driftwood Healthcare Center in Santa Cruz, Hearts & Hands Post Acute Care & Rehab Center, Pacific Coast Manor, Valley Convalescent & Rehabilitation Center, Santa Cruz Post Acute, Redwood Grove Post Acute, and Watsonville Nursing Center all hire CNAs.3
  • Home care and assisted living: SYNERGY HomeCare and Brookdale Scotts Valley recruit CNAs for one-on-one home care and assisted living or memory support settings.

Current demand and local hiring

Workforce data counted 528 nursing assistant jobs in Santa Cruz County in 2024, with average annual pay around $47,600.1 In early 2026, job boards showed about 200 openings for CNA jobs in Santa Cruz, CA, although not every posting was inside the county. Local reports do not officially label CNAs a shortage occupation, but steady hiring across hospitals, skilled nursing, and home care points to ongoing replacement demand.

How work setting shapes training choices

Hospital-bound students often benefit from programs with acute-care clinical rotations or extra skills like EKG and phlebotomy. Students aiming for skilled nursing can prioritize schools with clinical partnerships at local post-acute facilities. Ask a program coordinator where students complete clinical hours, because that is often your first direct connection to a hiring employer.

Pay and hiring incentives

Posted hourly pay varies by setting, as do many entry-level medical career salaries. Skilled nursing and post-acute jobs commonly advertise between roughly $21 and $30 per hour.2 A Dominican Hospital posting in early 2026 listed a hospital CNA or patient care technician role around $52.50 per hour, but that figure may include shift differentials or other factors.2 Employers may offer tuition reimbursement or hiring incentives for new CNAs, but these are not always posted publicly. Confirm current incentives with the facility or your school's job placement contact before enrolling.

Online and Hybrid CNA Programs Available to Santa Cruz Students

Several CDPH-approved programs let Santa Cruz students complete the classroom portion online, but California does not allow fully remote CNA certification. Online and hybrid options combine live Zoom or Canvas theory sessions with in-person clinical rotations at approved facilities, including some Santa Cruz, San Jose, and Bay Area sites. Start dates are not published in the state program listings below, so contact schools directly for the next available cohort.

Program NameFormatCDPH ApprovedTuitionStart Date
CAL ACE Nursing Academy Online/Hybrid CNA ProgramHybrid program with 60 hours of fully online theory via Zoom and 104 hours of in-person clinical rotations at partner facilitiesYes, CDPH-approved Nursing Assistant Training Program$1,798N/A
Health Star Academy 160-Hour CDPH-Approved Online CNA ProgramHybrid program with 60 hours of online theory coursework and 100 hours of in-person clinical training at approved local nursing facilitiesYes, CDPH-approved 160-hour Nursing Assistant Training ProgramN/AN/A
Lotus Medical Career College CNA Certification Program (Online CNA, Hybrid, Pomona Campus)Hybrid evening schedule with 10 days of CNA theory via live Zoom and Canvas, followed by 21 days of in-person clinicals at skilled nursing facilitiesYes, CDPH-approvedN/AN/A
Golden Heart School of Nursing E-Learning Nurse Assistant Training ProgramHybrid e-learning CNA program with 10 days of theory delivered online via Zoom and 15.5 days of in-person clinical training in a CDPH-approved healthcare facilityYes, CDPH-approved Online Nurse Assistant Training ProgramN/AN/A
Central Coast Nursing Institute Hybrid Certified Nursing Assistant ProgramHybrid CNA program with 60 hours of theory delivered online and 112 hours of in-person clinical trainingYes, California state-approved CNA training programN/AN/A
First Lady Permanente Nurse Assistant Program (Hybrid Track)Hybrid CNA program with 60 hours of online theory and 100 hours of in-person clinical training at approved sitesYes, CDPH-approved Nurse Assistant Training Program in CaliforniaN/AN/A

CDPH-Approved CNA Programs Within Commuting Distance of Santa Cruz

Santa Cruz County students have a genuine shortage of local classroom options, which pushes many toward a short drive into Watsonville, Aptos, or even farther south to Milpitas, where some students also look into CNA classes San Jose CA. Before enrolling anywhere, confirm current CDPH approval directly with the school and cross-check the state's certified list of CDPH approved CNA programs, since approval status can shift between renewal cycles and program pages don't always reflect the latest standing.

Programs in Santa Cruz and Watsonville

  • Monsbey College (Watsonville): Advertises a full CNA track with daytime, evening, and weekend sections, listing a total program cost near $2,000 split between a $200 registration fee and $1,800 in tuition. Verify CDPH status before enrolling, as the program's page does not spell out its current approval details.
  • Diamond School of Nursing (Santa Cruz): Markets itself as serving students near Santa Cruz with day, evening, and weekend scheduling, a strong fit for working adults. Confirm approval status directly with the school, since it isn't clearly documented on the source page.
  • Cabrillo College (Santa Cruz): A community college option with a daytime weekday schedule. Tuition itself is free, though students should budget roughly $100 for a clinical compliance fee and another $100 for uniforms and course materials, plus a state exam fee that varies. Approval status should still be confirmed before applying.

Programs Farther Afield

  • Central Coast Nursing Institute: Offers both a weekday track and a weekend program, with total costs around $1,680. This flexibility can matter for students juggling jobs or family care, though again, confirm approval before committing.
  • CAL ACE Nursing Academy (Milpitas): A longer commute for most Santa Cruz residents, but notable because it carries confirmed CDPH approval. Tuition runs $1,948 without employer sponsorship, or $0 if an employer sponsors the seat, a detail worth asking about if you already work in a healthcare setting.
  • Cabrillo College's Aptos-area clinical site: Referenced in county training documents covering the Watsonville, Aptos, and Santa Cruz corridor, though scheduling details weren't specified in available records.1

What to Verify Before You Commit

Because several of these listings lack clear, published CDPH confirmation, treat program pages as a starting point, not the final word. Call each school, ask for their current CDPH approval number, and request it in writing if possible. This single phone call protects you from wasted tuition and ensures your training hours will actually count toward state certification.

CNA Tuition, Fees, and Financial Aid in Santa Cruz

Budgeting for a CNA program in Santa Cruz means looking past the sticker price. Tuition is usually the biggest line, but registration, textbooks, uniforms, background checks, health clearances, and the state exam all add up. Here is how the numbers typically shake out locally, and where to look for help with paying for nursing school.

What You'll Actually Pay

Local totals span a wide range depending on the school:

  • Cabrillo College: Tuition is $0 for the 2026 CNA program. Out-of-pocket costs run about $325, covering clinical compliance ($100), scrubs ($100), a watch ($40), Student Health Services ($35), and background check ($50). The state exam fee is separate and to be determined.
  • Cal Ace Nursing Academy: Around $1,798 total, with a $200 registration deposit and installment options near $800. A separate Bay Area listing shows $1,948 without employer sponsorship, or $0 if you commit to post-graduation placement with a partner facility.
  • Monsbey College: Roughly $1,800, broken into $200 non-refundable registration plus $1,600 tuition. Some cohort listings show $2,000.
  • Watsonville/Aptos/Santa Cruz Adult Education: Approximately $2,862 combined for tuition, fees, and supplies (federal reporting; not itemized).

On top of tuition, plan for a Live Scan background check ($25 to $60), TB test and physical, CPR/BLS certification, and the California state exam (roughly $90 to $120, with a common rate near $105). Retakes run $35 to $40 per portion. CDPH does not charge an initial certification fee.

Financial Aid That Fits Short Programs

Most CNA courses are too short to qualify for federal Pell Grants on their own, so students rely on other channels:

  • WIOA (Workforce Innovation and Opportunity Act): Funds job-training programs through local America's Job Centers. Awards and covered expenses vary by county and applicant.
  • California College Promise Grant (CCPG): At Cabrillo, this waives enrollment fees for eligible California residents; it can pair with local scholarships to offset the remaining $325.
  • Employer sponsorship: Medicare and Medicaid certified nursing facilities are required to cover training costs for employees who complete their CNA within four months of hire. Cal Ace also offers a tuition-free pathway tied to post-graduation placement.
  • School payment plans: Cal Ace and Monsbey both accept installment payments to spread tuition across the program.

Ask each school in writing what its posted price includes, since exam, uniform, and background fees are frequently billed separately.

Admission Requirements and Prerequisites for Santa Cruz CNA Programs

CNA program requirements vary by school, but most Santa Cruz-area training sites expect applicants to meet health, identification, and physical ability standards before starting clinical work.

  1. Age minimum
    California allows CNA training at 16, and many local programs follow that. Cabrillo College requires students to be 18 by course completion, while Monsbey College and Diamond Nursing School list 16 as their minimum.
  2. High school diploma or GED
    Watsonville Adult School requires a diploma or GED for all health courses. Cabrillo does not require one for the CNA program, and Diamond lists a diploma as preferred but not required.
  3. Background check and identification
    All programs require a Live Scan background check before patient care. You will typically need a government-issued photo ID and a Social Security number or ITIN. Monsbey specifically lists a valid California ID and Social Security number.
  4. Health screenings and TB test
    Expect a clear TB test within six months (Cabrillo) or a negative TB skin test/chest x-ray (Monsbey). Required immunizations often include MMR, Varicella, flu, COVID-19, hepatitis B, and Tdap, though the exact list varies by facility.
  5. Physical exam and ability to perform the job
    Several programs require a physical exam. You should be able to lift and move patients safely; JobTrain, for example, lists lifting up to 20–50 pounds occasionally, 10–25 pounds frequently, and up to 10 pounds constantly during the program and clinical work.
  6. Program-specific tests and orientation
    Watsonville Adult School gives a reading and math entrance exam and requires co-enrollment in medical terminology. Monsbey may include an assessment and interview, while JobTrain includes an orientation and a basic skills assessment. Cabrillo does not list a CNA entrance exam.

State Exam Preparation and Pass Rates at Santa Cruz Schools

California's CNA certification hinges on one test with two parts, and a program's CNA exam preparation should weigh heavily in your school choice.

What the California CNA State Exam Covers

After completing a state-approved training program (at least 60 hours of theory and 100 hours of supervised clinical practice), you sit for the California Nurse Assistant Competency Evaluation, administered through the NNAAP. It has two components:

  • Written or oral exam: 60 multiple-choice questions covering care skills, safety, communication, resident rights, and basic nursing concepts. An oral version is available if English reading is a barrier.
  • Skills evaluation: You perform five randomly selected hands-on skills (handwashing is almost always one) in front of a state evaluator. Precision on infection control and patient safety steps is what separates passes from fails.

You must pass both parts. If you fail one, you retake only that portion; the CNA retake policy after failing skills gives you three attempts within two years of finishing training before you have to repeat the course.

Local Pass Rates: What Santa Cruz Schools Report

CDPH does not publish a public school-by-school CNA pass-rate table the way the Board of Registered Nursing does for RN programs, so the numbers you see locally come from the schools themselves. Treat them as self-reported until you can confirm directly with the program.

  • CAL ACE Nursing Academy (Santa Cruz): Reports a 99% first-time pass rate. Clinicals run at Redwood Grove Post Acute, and the program says it builds in practice and preparation opportunities for the state exam.
  • Nursing School Santa Cruz: Reports a 100% clinical pass rate and 97% on the written portion.
  • Monsbey CNA (Watsonville and Santa Cruz): Offers CNA training locally; published pass-rate data was not available at the time of writing.

Questions to Ask Before You Enroll

During your school interview, ask for the most recent first-time pass rate, whether they provide practice skills testing with a mock evaluator, and what support is available if you need a retake. A confident program will answer specifically.

A program's state exam pass rate is the clearest indicator of whether it truly prepares you for the bedside. Schools with pass rates above 90 percent demonstrate they are teaching the clinical and written skills that lead directly to certification and employment.
cnaclasses.org

Job Placement Assistance and Employer Partnerships

Job placement support in Santa Cruz varies more by funding model than by school size, and that distinction matters when you are choosing a program.

Career Services at Cabrillo College

Cabrillo College's CNA program in Aptos draws on the college's broader career services office, which offers resume help and interview preparation to all students. Cabrillo also maintains an educational partnership with the Santa Cruz County Office of Education, though this connection supports learning pathways rather than hiring. No Santa Cruz facility currently holds a named hiring agreement with Cabrillo's CNA track, so graduates lean on general campus job resources and community partners rather than a guaranteed pipeline into a specific nursing home or hospital.

Employer-Sponsored Pathways

CAL ACE Nursing takes a different approach, matching students to employer sponsors across several counties including Santa Cruz. Students accepted into a fully sponsored, zero-tuition seat receive resume coaching, interview prep, and a guaranteed job placement in exchange for committing to the sponsoring facility after graduation. Locally, Santa Cruz Post Acute has sponsored seats in the past but was listed as full as of this update, while Redwood Grove Post Acute has shown limited openings and also runs its own paid Earn and Learn training track. Availability at both facilities shifts throughout the year, so confirm current openings directly before counting on a sponsored seat.

Independent Placement Assistance

Diamond Nursing School offers job placement assistance, resume help, and interview preparation to its Santa Cruz-area students, though it does not name specific partner facilities or guarantee hiring outcomes. Treat this as helpful support rather than a promised job, and ask any school directly how many recent graduates it has actually placed locally.

Santa Cruz CNA Career and Salary Outlook

CNA pay in the Santa Cruz area runs above the California statewide median, though it still trails registered nurse wages. The table below compares median annual salaries and employment estimates for Santa Cruz, nearby Salinas, and the state overall. Salinas metro median data is not available in the May 2023 OEWS release, so that cell is left blank.

Metro AreaMedian Annual SalaryEmployment
Santa Cruz-Watsonville, CA metro$45,470420
Santa Cruz County$45,912420
Salinas, CA metroN/A1,000
Salinas area$47,582940
California statewide$41,850104,800

How to Become a CNA in California: Your Step-by-Step Path

Four-step pathway to California CNA certification: 160 hours of approved training, background check, state exam, and Nurse Aide Registry listing.

Top CNA Programs for Santa Cruz Students

Below are the top CNA programs serving Santa Cruz students, ranked by IPEDS completion data, accreditation status, and program fit for the Santa Cruz area. Gavilan College is the only campus within a realistic commute from Santa Cruz, while the other programs are included for students willing to relocate to other California regions. Program-level earnings data is not yet reported for most CNA programs, so affordability and state approval are emphasized here.

Gavilan College

#1

Gilroy, CA · ~$7,000/yr (est.)

Hispanic-Serving Institution

Best for: Santa Cruz County commuting students

Gavilan College is the strongest local option for Santa Cruz students because its Gilroy campus is roughly 30 miles away and the college publishes routes from Santa Cruz County. The CNA program is consolidated into a single 8.5-unit course offered each fall and spring, which can simplify commuting. Its published resident tuition of $46 per unit keeps the base cost low, but students should budget for uniforms, exams, and required health screenings.

  • Single 8.5-unit course each fall and spring
  • $46 per unit for California residents
  • Includes clinical training with 100% attendance required
  • CPR BLS Provider certification required before enrollment
  • State certification exam preparation built in
  • Costs beyond tuition include uniform, health exam, and drug screen

Pasadena City College

#2

Pasadena, CA · under $5,000/yr (est.)

Hispanic-Serving Institution

Best for: Budget-conscious California residents

Pasadena City College offers a straightforward Occupational Skills Certificate with a single required 6-unit course. This is an on-campus program in Pasadena, so Santa Cruz students would need to relocate or arrange temporary housing. Its low published tuition makes it budget friendly, but students should verify additional fees, uniforms, and clinical travel costs.

  • Occupational Skills Certificate program
  • One required 6-unit course
  • On-campus delivery in Pasadena
  • Eligible for California state certification exam
  • Prerequisites include age 16+, CPR, and 10th grade education
  • Random selection process for qualified applicants

MiraCosta College

#3

Oceanside, CA · $1,000 – $10,000/yr (est.)

Hispanic-Serving Institution

Best for: Accelerated learners wanting quicker certification

MiraCosta College provides an accelerated eight-week CNA program in Oceanside, which is not a realistic commute from Santa Cruz but may appeal to students who can relocate temporarily. The program reports average costs around $600 for California residents, including tuition, books, and exam fees, and limits each session to 20 students. Graduates have posted strong state exam pass rates.

  • Accelerated eight-week schedule
  • 64 hours theory, 104 clinical, 18 skills lab
  • Average cost $600 for California residents
  • Limited to 20 students per session
  • State exam pass rates at 100% written and skills
  • Requires ESL 150, CPR card, valid ID and SSN

Citrus College

#4

Glendora, CA · $4,000/yr (est. net price)

Hispanic-Serving Institution

Citrus College offers a Nurse Assistant Program at its Glendora campus, which is far from Santa Cruz and requires relocation for most students. The estimated tuition cost is around $341 before uniforms and supplies, and admission operates on a first-come, first-served basis for 15-30 students per semester. Mandatory orientation, physical exam, TB test, and CPR certification are required.

  • Prepares for California Nurse Assistant Certification
  • Estimated cost around $341 plus supplies
  • First-come, first-served admission
  • 15-30 students accepted per semester
  • Requires orientation, physical exam, TB test, CPR

Charles A Jones Career and Education Center

#5

Sacramento, CA · ~$17,000/yr (est.)

Charles A Jones Career and Education Center in Sacramento delivers a five-week, 192-hour on-campus training program for Santa Cruz students willing to relocate temporarily. Current tuition is $950 with scholarships available, though the college notes costs will increase in August 2026. The program includes CPR and does not require a high school diploma, but applicants must pass CASAS, background, and health clearances.

  • Five-week program, 192 total hours
  • Current tuition $950, scholarships available
  • Includes CPR certification
  • No high school diploma required
  • Requires CASAS Reading 234 and Math 214
  • Drug, criminal, and health clearances mandatory

Rio Hondo College

#6

Whittier, CA · $10,000 – $15,000/yr (est.)

Hispanic-Serving Institution

Rio Hondo College in Whittier offers two campus-based CNA pathways, both requiring relocation for Santa Cruz students. The standard program combines 72 hours of theory and 135 hours of clinical training, while a pre-certification option adds structured admissions steps like mandatory orientation and random selection. Both meet Title 22 regulations and prepare students for the state competency exam.

  • State-approved program
  • 72 hours theory and 135 clinical
  • Meets Title 22 regulations
  • Prepares for National Nurse Aide Assessment
  • Minimum age 16 years
  • Multiple course offerings annually
  • Total 6.5 units
  • Random selection admissions
  • Mandatory orientation required
  • Requires California ID or SSN/ITIN
  • CPR, background check, vaccinations required
  • Focus on geriatric and emergency care

Institute of Technology

#7

Clovis, CA · ~$23,000/yr (est.)

Institute of Technology offers a Level One Nursing Assistant program at its Clovis campus, which is not commutable from Santa Cruz. The training meets California Department of Public Health requirements and includes career support such as interview preparation and employer connections. Students should confirm total costs, as published financial details are limited for this private program.

  • Meets California DPH requirements
  • Hands-on campus training in Clovis
  • Prepares for competency evaluation exam
  • Career support includes interview and employer networking
  • Reported 86% graduation and 72% employment rates
  • License exam pass rate reported at 100%

Imperial Valley College

#8

Imperial, CA · under $5,000/yr (est.)

Hispanic-Serving Institution

Imperial Valley College provides a one-semester, campus-based CNA/HHA program in Imperial, a significant relocation for Santa Cruz students. The program requires students to be at least 17 and able to lift 35 pounds, plus physical exam, immunizations, background check, and CPR. Low in-state costs make it affordable, but equipment and exam fees add to the total.

  • One-semester campus program
  • State certification eligibility
  • Age 17+ and 35lb lifting requirement
  • Clinical training included
  • Physical exam, immunizations, background, drug screen
  • State exam fee $100
  • Textbooks, uniform, stethoscope required

College of the Sequoias

#9

Visalia, CA

Hispanic-Serving Institution

College of the Sequoias in Visalia offers a Skill Certificate in Certified Nurse Assistant that consolidates training into one 6-unit course. Santa Cruz students would need to relocate for this campus-based program. The curriculum covers both physiological and psychological patient care and requires a grade of C or better, plus CPR and criminal background clearance.

  • Skill Certificate in Certified Nurse Assistant
  • Campus-based in Visalia
  • One 6-unit course requirement
  • Requires grade C or better
  • CPR certification and background check required
  • Prepares for State Certifying Exam

Reedley College

#10

Reedley, CA · $1,000 – $10,000/yr (est.)

Hispanic-Serving Institution

Reedley College offers a one-semester Nursing Assistant Training program at its Reedley campus, requiring relocation for Santa Cruz students. Clinical practice takes place at a local retirement community, and the program is accredited by the California Department of Public Health. Financial aid is available, but students must complete a mandatory orientation and meet health requirements.

  • Campus-based one semester program
  • Clinical practice at retirement community
  • Prepares for state certification exam
  • Mandatory orientation required
  • Physical exam, TB test, MMR immunization
  • Accredited by California Department of Public Health
  • Financial aid options available

Frequently Asked Questions About CNA Classes in Santa Cruz

Here are quick answers to the questions Santa Cruz CNA students ask most often. Program details can change between cohorts, so treat this as a starting point and confirm current schedules, fees, and prerequisites with each school before you apply.

  1. How long does it take to become a CNA in Santa Cruz?

    Most CDPH-approved programs require 160 total hours: 60 classroom hours and 100 clinical hours. Durations vary by school. CAL ACE advertises 3-week or 7-week routes, Watsonville Adult School's fall section runs about 7 weeks1, and Cabrillo College's 160-hour format is often completed in about 6 to 8 weeks, though Cabrillo has not published a fixed schedule. Check current cohort dates.

  2. Do any Santa Cruz CNA programs offer online theory classes?

    Current local program listings do not clearly confirm an online theory option for Santa Cruz students. Cabrillo College and Watsonville Adult School appear to use in-person formats, and Monsbey College does not advertise online or hybrid delivery. Some programs may require in-person clearance sessions. If online theory is important, contact the school directly before enrolling, because scheduling details are not always published.

  3. What is the cheapest CNA program in Santa Cruz after fees?

    Cabrillo College is the cheapest structured option among published Santa Cruz programs. Tuition is free, with a total of about $325 in fixed itemized fees, excluding variable immunization provider costs and the state exam fee. By comparison, Watsonville Adult School lists a $1,700 course fee plus materials1, and Monsbey College publishes roughly $1,800 to $2,000 in institutional costs.

  4. Are there weekend or evening CNA classes in Santa Cruz?

    Yes, some flexibility exists, but current schedules are not fully documented for every cohort. Monsbey College advertises weekday, evening, and weekend options, though exact cohorts may vary. CAL ACE's 3-week and 7-week routes suggest compressed versus spread pacing, and evening or weekend availability is implied but not explicitly verified. Cabrillo and Watsonville have not published specific day, evening, or weekend timetables for all sections.

  5. What are the admission requirements for CNA programs in Santa Cruz?

    Requirements vary by school. Cabrillo requires applicants to be 18 or older, have government ID and work eligibility, complete a TB test within six months, pass a background check and Live Scan, and meet site-specific immunizations and a physical. Monsbey accepts students 16 and older with a 7th grade English level and requires an assessment or interview, TB, physical, fingerprinting, and insurance. Watsonville requires a high school diploma or GED, passing reading and math exams, and medical terminology co-enrollment unless previously completed.1

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