Arkansas Reciprocity Form (For placement on the Arkansas Nurse Aide Registry via Interstate Transfer Form supplemental to form DMS-798 [R. 2/2015])

Nursing Student or RN Candidate Examination Application in order to qualify to take the state of Arkansas nurse aide competency exam.

This form is for DHS-approved Nurse Aide Instructors in Arkansas who would like to request access to TMU.

Application to be certified as an RN Test Observer/Test Administration Services Entity (TASE) for Nurse Aide Competency Exam testing services in the state of Arkansas.

Application to be certified as an Actor for Arkansas nurse aide competency testing.

Application to be certified as a Knowledge Test Proctor (KTP) for Arkansas nurse aide competency testing.

Complete this form for out-of-state work hours to qualify for renewal on the Arkansas nurse aide registry.

This form is to update, change or correct the spelling of your name or update/correct your social security number in your TMU© account.

Employment Verification for Funding

This application is to request a review of your test results or dispute any other condition of your testing that you think altered the outcome of your test. You must submit the $25 non-refundable test review fee and a detailed explanation with this Test Review Request. We recommend calling D&SDT-HEADMASTER staff for a test results consultation before submitting this form with your test review fee. NOTE: Please refer to the Candidate Handbook ‘Test Review Requests’ section.

In compliance with the Americans with Disabilities Act (ADA), the testing program provides reasonable accommodations for applicants with disabilities that may affect their ability to take the Competency Examination. For any questions, please call D&SDT-Headmaster at (800)393-8664.

Complete this form if you need to submit No Show Exception documentation.