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Out-of-State Nurse Aide Training Waiver Form 1101 Application

You must attach an image of your completion of training certificate from a reciprocity-approved state listed below:

Michigan requirements for reciprocity include, but are not limited to: 
  • The training program is consistent with the Federal Code of Regulations 
  • Requires a minimum of 75 course hours prior to taking a competency evaluation examination and does not allow candidates to exempt out of the training course hours or testing 
  • Approved states include: ALABAMA, ALASKA, ARIZONA, ARKANSAS, CALIFORNIA, COLORADO, CONNECTICUT, GEORGIA, HAWAII, IDAHO, ILLINOIS, INDIANA, IOWA, KANSAS, KENTUCKY, LOUISIANA, MAINE, MISSISSIPPI, MISSOURI, NEBRASKA, NEVADA, NEW HAMPSHIRE, NEW JERSEY, NEW MEXICO, NEW YORK, NORTH DAKOTA, OHIO, OKLAHOMA, OREGON, PENNSYLVANIA, SOUTH CAROLINA, SOUTH DAKOTA, TENNESSEE, TEXAS, UTAH, WASHINGTON and WISCONSIN
Your application is not complete until the required information and documentation are included, then select “Send Application.”
Address
Completion of Training Certificate
Affidavit
  • I have completed a training program that is consistent with the Federal Code of Regulations from one of the approved states.
  •  I have completed a minimum of 75 course hours from one of the approved states.
    • I have uploaded my Completion of Training Certificate.
By Submitting
I hereby verify that I understand and agree with the statements contained herein and the above information is true and correct.