Account Applications Create

MEDICATION AIDE-CERTIFIED: Test Site Application

Please complete this application to become an approved Test Site. Attach pictures of your test site knowledge exam test room layout (if your site does on-site knowledge exam testing) 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 document, and you have attached the required test site images if applicable. Please print the Test Site Agreement document and keep it for your records.

Test Site Agreement

Once you have completed all the fields in this application and uploaded the required images, select 'Send Application' to submit it.

Name

Fax

Phone

Alt Phone

Administrator

Address

City

State

Zipcode

Mailing Address

Address

City

State

Zipcode

Additional Facility Information

Discipline Select the discipline type you are applying for.

Parent Facility Select the parent facility for this facility.

Test Site Type

Choose which type of Test Site you would like to be: The Test Site Agreement has two options to consider when becoming a Test Site. Please refer to it to choose which type of Test Site your facility will be.

Candidate Directions

Additional Directions: Candidates receive a confirmation letter with the address of your facility upon scheduling. If you have any additional directions for how to get there or where to go once they arrive, please provide that information here. (For example, landmarks to look for, parking lot to use, building number, entrance number, floor and room number, or any other directions that help candidates get to your test site.

Test Site Images

Upload images of the test site knowledge test room (if your site does on-site knowledge exam testing), if applicable. Please upload images of your knowledge test site room layout.

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 hereby 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©.

By Submitting

I hereby verify that I understand and agree with the statements contained herein and the above information is true and correct.