Submit New Application

Self-Attested Renewal Application

Please read these directions completely before you complete this form online. Your request for renewal cannot be processed if it is incomplete, illegible, or includes false statements.

Complete this form and upload the required documents.
  • Completing this form requires an uploaded image of either:
    • A paycheck stub or a W-2 showing proof of at least 8 hours working as a Nurse Aide in a nursing home, hospital, or hospice within the previous 24 months.
You will be renewed on the Tennessee registry if you are qualified after the following is successfully completed:  
  • You have uploaded a paycheck stub or a W-2 from your out-of-state or closed-down employer.
Successful submission for Tennessee renewal can be verified by checking your status on the Tennessee NA Registry at https://tn.tmutest.com.

Your application is not complete until the required information is included, then select 'Send Application'.
Demographics
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Address
Recertification Information
Document Images
Affidavit
  • I have uploaded my paycheck stub or a W-2 showing proof of at least 8 hours working as a Nurse Aide
I agree that if all the requested documentation is not submitted with this application, and I do not reply to any of D&SDT-Headmaster's *emailed requests within one (1) month of submitting my application, my application will be denied, and I will need to resubmit a new application.

*NOTE: If you have an iCloud email, you may not receive our communications and need to call to check your status.

By Submitting
I hereby verify that I understand and agree with the statements contained herein and the above information is true and correct.
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