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It requires the candidate’s name to match government-issued identification exactly and explains legal name-change documentation when applicable. It covers ADA testing accommodations, including the need to submit an ADA Accommodations Request Packet at least 30 days prior, and highlights that oral (audio) exam takers do not need ADA accommodation requests. 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If the name does not match EXACTLY, you will not be permitted to take your exam and will forfeit any test fees.  \nIf you have previously taken a nurse aide exam with Prometric and your legal name has changed since then, you must provide a copy of acceptable legal documentation along with this application . Acceptable documents include marriage certificate; divorce decree; birth certificate; and legal name change court documents. Prometric will be unable to process your application until the legal acceptable documents are received.  \n• If applying for Testing Accommodations under the Americans with Disabilities Act (ADA):  \n• Please go [to www.prometric.com/request-accommodations](to www.prometric.com/request-accommodations) to print the required ADA Accommodations Request Packet. This packet MUST be completed and submitted with this application.  \n• Fill out the box below.  \nNote: Candidates applying to take the Oral (audio) Exam do not need to apply for ADA accommodations.  \nI am applying for Americans with Disabilities Act (ADA) accommodations. I am requesting testing accommodations and have included the required ADA Accommodations Request Packet along with this application . I understand I must request accommodations 30 days in advance of the test date and not all accommodations can be approved.  \n􀂆 Yes 􀂆 No  \nCandidate Information  \nAll fields marked with * are required. Print one number/letter in each box where required.  \n\n| *Have you taken a Certified Nurse Aide exam with Prometric? 􀂆 Yes 􀂆 No |  |  |\n| --- | --- | --- |\n| *Social Security Number\u003Cbr>􀀍􀀍􀀍-􀀍􀀍-􀀍􀀍􀀍􀀍 |  |  |\n| *First Name 􀀍􀀍􀀍􀀍􀀍􀀍􀀍􀀍􀀍􀀍􀀍􀀍􀀍􀀍􀀍􀀍􀀍􀀍􀀍 |  | Middle Initial\u003Cbr>􀀍 |\n| *Last Name 􀀍􀀍􀀍􀀍􀀍􀀍􀀍􀀍􀀍􀀍􀀍􀀍􀀍􀀍􀀍􀀍􀀍􀀍􀀍􀀍􀀍􀀍􀀍 |  |  |\n| *Date of Birth (Month/Day/Year)􀀍􀀍 / 􀀍􀀍 / 􀀍􀀍􀀍􀀍 | Previous name (if applicable): |  |\n\n\n| *Street Address (including Apt. number or P.O. Box, if applicable) |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- |\n| *City *State *ZIP Code\u003Cbr>􀀍􀀍 􀀍􀀍􀀍􀀍􀀍 |  |  |  |  |  |\n| *County (first four letters only) |  |  | * Phone Number (including area code)􀀍􀀍􀀍-􀀍􀀍􀀍-􀀍􀀍􀀍􀀍 |  |  |\n| *Email Address (application will not be processed without an email address) |  |  |  |  |  |\n| Ethnic Group (optional) (check one box)\u003Cbr>􀂆 American Indian or Alaskan Native\u003Cbr>􀂆 Mexican American\u003Cbr>􀂆 Other |  | 􀂆 Asian American/Pacific Islander 􀂆 Black/African American\u003Cbr>􀂆 Other Hispanic or Latin American 􀂆 White |  |  |  |\n| Gender (check one) 􀂆 Female 􀂆 Male |  |  |  |  |  |\n| Education Level (Optional) Check only one box next to your highest education level completed.\u003Cbr>􀂆 4th grade or less\u003Cbr>􀂆 Between 5th and 8th grades\u003Cbr>􀂆 Some High School, did not graduate\u003Cbr>􀂆 High School diploma or GED\u003Cbr>􀂆 One or two years of college\u003Cbr>􀂆 Two-year + college degree |  |  |  |  |  |\n| *Current Nursing Home Employment Status:\u003Cbr>Full Time  Part Time  Not Employed\u003Cbr>(If you are currently working in a nursing home, have your Employer complete Section 2 of this application) |  |  |  |  |  |\n| Do you currently hold a certification as a nurse aide or are you listed on the nurse aide registry in any state other","cbCainvMQfkoLguS","https://ap.wps.com/l/cbCainvMQfkoLguS","pdf",249057,7,"English","# Candidate Information\n## Certification Option/Eligibility\n## Training Information","[{\"question\":\"What are the submission and document quality requirements for the application?\",\"answer\":\"Print and mail the application along with the appropriate fee, including the Payment Form at the end. Submit only complete, not blurred or illegible forms; incomplete or illegible applications will not be processed.\"},{\"question\":\"Why must the candidate name match the government identification exactly?\",\"answer\":\"The name on the application must match the exact name on the government-issued identification provided on test day. If it does not match exactly, the candidate will not be permitted to take the exam and will forfeit any test fees.\"},{\"question\":\"How do ADA testing accommodations work for this exam?\",\"answer\":\"Candidates applying for ADA accommodations must complete and submit the required ADA Accommodations Request Packet with the application and request accommodations at least 30 days before the test date. Not all accommodations can be approved. Candidates taking the oral (audio) exam do not need to apply for ADA accommodations.\"}]","APPCNANY - New York Certified Nursing Aide Examination Application | PDF",1789836983]