In-Facility Nurse Aide Test Site Application

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All data submitted on this application shall be classified as public information once the approval is issued. Minnesota Statutes, section 13.04 (https://www.revisor.mn.gov/statutes/cite/13.04).

In-facility testing can be a convenient option for both nurse aide candidates and nursing home employers. By testing nurse aide candidates within the facility where training occurs, candidates may experience a reduction in the distance to travel to an off-site testing center, increase the comfort level of testing at a familiar location, and shorten the time to enter the workforce as qualified professionals.

If your facility is interested in in-facility testing, please review the details of the In-Facility Nurse Aide Testing Site Guide (Nurse Aide Registry: In-Facility Testing - MN Dept. of Health) before completing this form. If you meet all the requirements to become a test site, complete all fields listed below and submit it to MDH. MDH will review and notify interested facilities within 30 days via email if you have been approved to become a in-facility test site. For questions on this form and process, please contact MDH at health.nar.coord@state.mn.us.

Approved training programs offered by colleges within the facility or at: colleges, high schools, independent free-standing programs, or assisted living facilities that train staff for their licensed only facility are not eligible to be in-facility testing sites. Any NATCEP (Nurse Aide Training and Competency Evaluation Program) who has provisional approval will not qualify for an in-facility test site.

It is a requirement for in-facility test sites to be willing to test external nurse aide candidates from outside your NATCEP (Nurse Aide Training and Competency Evaluation Program). By submitting this application you are acknowledging external candidates will be tested at your site.

All fields below are required to be completed in order to submit this application.

Facility Name

Facility Street Address

Facility City/Town

Facility State

Facility ZIP/Postal Code

NATCEP Name

NATCEP Training Code

NATCEP Main Contact Name

NATCEP Main Contact Title

NATCEP Main Contact Email

NATCEP Main Contact Phone

1) List up to three most common test site locations where your students currently test:

2) Please select the description below that best defines your NATCEP:

3) Have you reviewed the Test Site Equipment List (Form 1503MN) to confirm that all necessary equipment and supplies are obtained? It is required to have all items listed on the 1503MN within three months of test site acceptance by MDH. At this time, please do not complete or submit the 1503MN form.

Test Site Equipment List Form 1503MN (opens in new window)

4) Do you have at least one staff member that is accountable to manage and develop process for test sites, complete required Headmaster forms timely and coordinate ongoing testing events, this includes application and pictures?

5) How do you intend to staff the test events at your site?

6) Select which tests you intend to provide at your testing site:

7) If administering the Knowledge test, select which version you intend to provide:

8) If you selected to use your own staff to run test events, do you have at least one eligible individual for each of the roles of RN Test Observer, Actor and Knowledge Test Proctor (if performing onsite knowledge tests)? The Knowledge Test Proctor can also be the RN Test observer.

Re-order	RN Test Observer	Actor	Knowledge Test Proctor/Or RN Test Observer	Weight	Operations
	RN Test Observer Yes No	Actor Yes No	Knowledge Test Proctor/Or RN Test Observer Yes No	Item weight

9) How many students enrolled in your NATCEP program during the last calendar year successfully completed the course?

10) Please explain your interest or need in becoming an in-facility test site and describe any challenges you face with access to current testing.

11) If approved as a test site, your organization must begin testing within three months of approval. To ensure successful implementation, your organization must:

Identify and secure all staff needed to support in-facility testing.
Complete all required applications in a timely manner.
Obtain the necessary supplies and equipment for testing operations.
Attend all mandated trainings, meetings, and open office hours.
Respond promptly to all communications from MDH and HM.

Do you foresee any challenges within your organization that could hinder your ability to meet these requirements? Examples might include staffing shortages, loss of NATCEP status, or ownership transitions.

By submitting this form, you confirm your organization’s commitment to securing testing supplies, implementing testing within three months, and complying with the requirement to test external nurse aide candidates who are not part of your NATCEP program.

In-Facility Nurse Aide Test Site Application

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