AR CNA Reciprocity 9110AR Application

DO NOT COMPLETE THIS FORM if you have ever previously been listed on the Arkansas Nurse Aide Registry. You can check for the status of your AR listing on the Arkansas NA Registry at: 

Please read these directions completely prior to continuing and submitting this form. Your request for reciprocity cannot be processed if it is incomplete, illegible, or includes false statements. 

Complete this form 9110AR, upload the required identification documents, and pay the non-refundable processing fee of $25 through the secure credit card processing portal. Completing this form requires an uploaded image of your:
  •  Social security card and;
  •  An image of your valid US government-issued photo identification (state driver’s license, passport, or other signed, current, photo identification) 
Your application is not complete until the required information is included, then select “Send Application.”
Reciprocity Information
Military Member Status
Required Questions
Images of the following documents must be included.
  • I have uploaded my current US government-issued, signed photo ID.
  • I have uploaded my social security card.
    • *NOTE: If you have an iCloud email, you may not receive our communications and you may need to call to check your status.
I agree that if all the requested documentation is not submitted with this application, and I do not reply to any of D&SDT-Headmaster's *emailed requests within one (1) month of submitting my application, my application will be denied and I will need to resubmit a new application and repay the fee.
By Submitting
I hereby verify that I understand and agree with the statements contained herein and the above information is true and correct.
Application Fee $25.00
Non-Refundable. All fees are non-refundable.