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MEDICATION AIDE: Out-of-State Medication Aide Training Waiver 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
Approved states include: INDIANA, OHIO and WISCONSIN

Your application is not complete until the required information and documentation are included, then select “Send Application.”

Legal First Name

Middle

Legal Last Name

Birthdate

Phone

SSN

Gender

Male Female Other

Address

City

State

Zipcode

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 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.