Submit New Application

RN Instructor Application

Complete this form and submit it. Once approved, you will receive a login to Wyoming TMU where you can enter and complete nurse aide students which will allow them to register and take the nurse aide state competency exams.

Legal First Name

Middle

Legal Last Name

Birthdate

Phone

SSN

Gender

Male Female Other

Address

City

State

Zipcode

RN License Information

License Number

Expires

Nurse Aide Training Program Affiliation Please enter the name of the training program where you are an instructor.

Nurse Aide Training Program Affiliation Program Number Please enter the training program number where you are an instructor.

Affidavit

I attest that by completing this application:

I am an active RN and
I have met the requirements of a Wyoming nurse aide instructor and can enter and certify completion of training of nurse aide candidates (as per federal guidelines § 483.152 requirements for approval of a nurse aide training and competency evaluation program).

By Submitting

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