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Knowledge Test Proctor (KTP) Training Affidavit and Confidentiality/Nondisclosure Agreement Application

BECOMING A KNOWLEDGE TEST PROCTOR (KTP): 
To become a KTP, you must review and be trained with the KTP Training Materials by a certified RN Test Observer.  You must also meet the criteria listed below. After accomplishing these tasks, you may then be used as a KTP. 

To qualify as a KTP, you must meet the following criteria:  
  • KTPs need to understand that they are not able to sit for the Michigan NA competency test for six (6) months from the date that they last worked as a KTP. 
  • KTPs must be of legal working age in Michigan. Minors must also have a work permit where required by State law. 
  • KTPs must be trained and certified with these approved materials. 
  • A KTP may NOT be a Nurse Aide Test Candidate who has not been tested. 
  • A KTP may NOT be a Nurse Aide Training Program student. 
  • A KTP may NOT be the Nurse Aide Test Candidate's instructor.
  • KTPs can be registry active Nurse Aides, testing team family members, volunteers, etc. 
Once you have completed all of the fields within this document, select “Send Application" to submit your application.
Address
RN Test Observer Name
Affidavit
As a Knowledge Test Proctor (KTP), I swear that I have reviewed the KTP Training Materials with the RN Test Observer named, and I understand and will abide by the approved material presented. Click to open:  Link to KTP Training Materials.
  • I understand that as a KTP, I will not be permitted to apply and take the State Nurse Aide exam for 6 months from the date that I last worked as a KTP.
CONFIDENTIALITY/NONDISCLOSURE AGREEMENT:
I acknowledge the confidential nature of the nursing assistant competency examination. This includes the materials, processes, procedures, and content of the examination's knowledge and manual skills portions.
  •  I agree to safeguard the confidentiality of all information about the nursing 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, nor will I disclose any test content, examination results, or information about any Nurse Aide candidate's performance with instructors or administrators of any training facility, program, or with anyone else other than the RN Test Observer, D&SDT-HEADMASTER staff, or the appropriate State agency.  
  • I will not be involved in testing family members or close personal friends, except in emergency situations as provided for in the D&SDT-HEADMASTER and State Guidelines.
TEST SECURITY: 
I will maintain and never violate the tests' security or compromise any testing information. I understand that if I violate test security, I will be held legally accountable and prosecuted to the full extent of the law.
By Submitting
I hereby verify that I understand and agree with the statements contained herein and the above information is true and correct.
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