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TN Reciprocity Form 9110

Tennessee Reciprocity Form (For reciprocity placement on the Tennessee Nurse Aide Registry via Interstate Transfer.)

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NURSE AIDE: Primary Nurse Aide Training Instructor Login Request Form

This form is for HFC-approved Nurse Aide Instructors in Tennessee who would like to request access to TMU©.

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RN Test Observer | Test Administration Services Entity (TASE) Application - $100.00

Application to be certified as an RN Test Observer/Test Administration Services Entity (TASE) for Nurse Aide Competency Exam testing services in the state of Tennessee.

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Actor Training Affidavit and Confidentiality/Nondisclosure Agreement

Application to be certified as an Actor for Tennessee nurse aide competency testing.

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Knowledge Test Proctor (KTP) Training Affidavit and Confidentiality/Nondisclosure Agreement

Application to be certified as a Knowledge Test Proctor (KTP) for Tennessee nurse aide competency testing.

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MEDICATION AIDE: Primary MA Training Instructor Login Request Form

This form is for TBON-approved Medication Aide Instructors in Tennessee who would like to request access to TMU©.

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NA/MA: DEMOGRAPHIC CHANGE/CORRECTION REQUEST FORM

This form is to update, change or correct the spelling of your name or update/correct your social security number in your TMU© account.

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NURSE AIDE TEST SITE

This application is for Facilities who would like to become approved Nurse Aide Test Sites.

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NA/MA: TEST REVIEW REQUEST AND PAYMENT FORM - $25.00

This application is to request a review of your test results or dispute any other condition of your testing that you think altered the outcome of your test. You must submit the $25 non-refundable test review fee and a detailed explanation with this Test Review Request. We recommend calling D&SDT-HEADMASTER staff for a test results consultation before submitting this form with your test review fee. NOTE: Please refer to the Candidate Handbook ‘Test Review Requests’ section.

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ADA ACCOMMODATION REQUEST

In compliance with the Americans with Disabilities Act (ADA), the testing program provides reasonable accommodations for applicants with disabilities that may affect their ability to take the Competency Examination.

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Request to Become Employer in TMU©

This application is for employers who would like to be registered in TMU© as an eligible employer to verify the employment of nurse aides for the renewal of their Federal certification.

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Self-Attested Renewal

Complete this form if you qualify for a self-attested renewal on the Tennessee Nurse Aide Registry.

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No Show Exception Form

Complete this form if you need to submit No Show Exception documentation.

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