Facility Application
*Denotes required information
 
 
 
 

Thank you for your interest in being a Nurse Aide Testing Facility! We have a few questions below to get you started.


Email:
Will be used to access
your Facility Account
*

Password:
Greater than 8 characters
Upper, lower, and number
For multiple sites, use same password for all sites.		*

Facility Name     Contact Name   
Phone   

Do you want to do testing for your students (INF) or do you want open your site up for outside students (RTS) testing?


Extension 
Mobile Phone 
Fax 
I am applying to be an RTS or an INF?    

Where are you located?

Facility AddressMailing Address
Use Same Address for Admin
Address 1     Address 1  
Address 2  Address 2 
City    City 
State    State
Zip    Zip 
Main Phone 
Directions
 

Can you please provide a few details about your facility's capabilities for Nurse Aide Certification Testing?

If you have any questions about these items we are happy to help you later.

Skills Room Fax Phone# 
Written Room Fax Phone# 
Physical Beds
Mannequins
Catheters
Max Candidate Capacility Written Room
Skill Labs
Does your site have a Separate Room for Accommodations #
Approximate Days Per Month Available for Testing

Do you have any additional notes or questions?

Notes:

Please upload photos of your facility demonstrating it meets the requirements for testing?

If you have any issues uploading your pictures, we are happy to help you later.

Submit Application