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MEDICATION AIDE: Test Site Application

Please complete this application to become an approved Test Site. Attach pictures of your test site knowledge exam room layout (if your site does on-site knowledge exam testing), the skills lab room layout, equipment, and supplies for review. In the Affidavit at the end of this document, you will attest that you have read, understood, and will abide by the following documents, and you have attached the required test site images. Please print these documents and keep them for your records.

Click to Open: Test Site Agreement
Click to Open: Test Site Equipment List (the equipment, supplies, and room requirements that must be available and in good working order to be a test site)

Once you have completed all the fields in this application and uploaded the required images, select “Send Application" to submit it.
Address
Mailing Address
Additional Facility Information
Test Site Type
Candidate Directions
Test Site Images
Affidavit
TEST SITE AGREEMENT: (Keep a copy of this form for your records.)  Click on the Test Site Agreement  to open the document.
  • I hereby agree to and understand that our Facility will allow Medication Aide Knowledge Tests to be administered under the guidelines in the Test Site Agreement.  
  • I certify that our site is not under authoritative sanctions, and I have read, understood, and will abide by all listed guidelines in the Test Site Agreement. 
  • I certify that our Facility has the room requirements (distraction and interruption-free testing room) to administer medication aide knowledge tests to medication aide candidates at our test site for days we have scheduled test events in TMU©.
TEST SITE EQUIPMENT LIST: (Keep a copy of this form for your records.)  Click on the Test Site Equipment List  to open the document.
  • I hereby certify that our Facility has the equipment, supplies, and room requirements listed in the Test Site Equipment List and will make the equipment and supplies available to certified RN Test Observers to administer medication aide knowledge and skill tests to medication aide candidates at our test site for days we have scheduled test events in TMU©.  
By Submitting
I hereby verify that I understand and agree with the statements contained herein and the above information is true and correct.