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MEDICATION AIDE: RN Test Observer | Test Administration Services Entity (TASE) Application

Please fill out this application if you are an active Nurse Aide Test Administration Service Entity and would like to also administer Medication Aide exams.

There is a non-refundable one-time fee of sixty-five dollars ($65.00) to certify that you have the necessary qualifications to administer exams that meet State testing standards. Please complete the credit/debit card certification fee payment information when you submit this application.

You will attest in the Affidavit at the end of this document that you have read, understand, and will abide by the following documents.  Please print these documents and keep them for your records.

Once you have completed all the fields and uploaded the required documents within this application, select 'Send Application' to submit your application. 

*If you ARE NOT a Michigan Nurse Aide TASE and would like to administer Medication Aide exams, please call (888) 401-0462*
RN License Information
I acknowledge the confidential nature of the medication assistant competency examination, including the materials, processes, procedures, and content of the knowledge and manual skills portions. 
  • I agree to safeguard the confidentiality of all information about the medication assistant competency examination. 
  • I will not disclose any portion of the examination materials.
  •  I will not disclose the processes or procedures necessary to administer or pass the examination.
  •  I will not disclose any examination results to instructors or administrators of any training facility or program.
  • I will not test or be involved in testing students I have trained or had professional contact with during training, family members, or close personal friends.
I understand that this agreement extends to and includes, but is not limited to, allowing unauthorized persons to hear, view, videotape, or otherwise gain any knowledge about the exam before, during, or after the administration of an exam.  I recognize that disclosing or revealing, or allowing this information to be disclosed or revealed, constitutes a violation of this agreement and could place my nursing license at risk and/or be subject to prosecution to the full extent of the law and/or a $100,000 fine. I agree to immediately report any known or suspected breach in security relative to the nurse aide competency examination by calling the D&SDT-HEADMASTER home office at (800)393-8664.

As a certified RN Test Observer, I swear that I have provided and reviewed and will abide by the Actor training material and Knowledge Test Proctor training guidelines with any individual(s) I choose to use as an Actor or Knowledge Test Proctor.   Click the following links to open the Actor Training Guidelines and KTP Training Guidelines.
  • I attest that the individual(s) I choose to use as my Actor and/or KTP have completed the Actor and/or Knowledge Test Proctor (KTP) Training Affidavit and Confidentiality/Nondisclosure Agreement Applications available at
  • I also understand that any Actor or Knowledge Test Proctor I choose to use will not be able to sit for the Medication Aide test for six (6) months from the date that I last used them as an Actor or Knowledge Test Proctor.
RN TEST OBSERVER-TEST SITE EQUIPMENT LIST: (Keep a copy of this form for your records.)  Click on the RN Test Observer-Test Site Equipment List to open the document.
I hereby certify that the test sites where I test will be checked before starting each test event to ensure that the area is distraction—and interruption-free and that the test site equipment listed on the Test Site Equipment List is available and in good working order. If not, I will report missing or inoperable test site equipment by listing it in TMU© under the test discrepancies before submitting my test event observations for scoring. I will carry at least the minimum equipment/supplies listed on the Additional Equipment Normally Provided by RN Observer for each test event I manage.

TEST ADMINISTRATION SERVICES (TASE) AGREEMENT (1505MI-MA TASE):  (Keep a copy of this agreement for your records.)  Click on the 1505MI-MA TASE AGREEMENT FORM to open the document.
I hereby certify that I have read, understood, and will abide by the terms and conditions of the Testing Services Business Entity Agreement Form (1505MI-MA TASE) as established by statute in the State of Michigan to do business.  
  • I understand that there is a non-refundable one-time fee of sixty-five dollars ($65.00) to certify that I have the necessary qualifications to administer exams that meet State testing standards.
  • I am a Nurse Aide TASE with D&SDT-HEADMASTER
By Submitting
I hereby verify that I understand and agree with the statements contained herein and the above information is true and correct.
Application Fee $65.00
Non-Refundable. All fees are non-refundable.