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Certified Medication Aide I Challenge- Nursing Students Application

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Section II

Are you currently listed on the Kentucky Nurse Aide Registry?

Section III

Nursing School Attended:

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Dean of Nursing:

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Official Transcript- Nursing Students

Course Syllabus-Nursing Students ***If your pharmacology class did not include a clinical rotation in a healthcare facility, please include the syllabus from the nursing course completed that included the opportunity to perform medication passes in a healthcare facility during a clinical rotation.

Verification of active nurse aide registry status with KY Board of Nursing

Affidavit

I have attached ALL required documentation as requested for verification to determine eligibility to challenge the Certified Medication Aide I examination.

If approval to test is received, the exam fee of $50.00 and scheduling is handled through the TMU system.

By Submitting

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