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: https://ar.tmutest.com
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.”