The CDPH 279 DSD/Instructor Application is the required submission for California healthcare professionals applying for certification as a Director of Staff Development (DSD) or Instructor. The California Department of Public Health's Licensing and Certification Program reviews this form to confirm that applicants meet state and federal standards for leading health education and training programs in licensed facilities, including skilled nursing facilities, intermediate care facilities, schools, and agencies.
Who must apply: Any registered nurse (RN) or licensed vocational nurse (LVN) who plans to deliver orientation, in-service training, or certification programs at a licensed California healthcare facility must hold CDPH DSD or Instructor approval. The approval process begins with a complete Form 279 packet submitted to CDPH.
Required credentials and documents: Your packet must include your current RN or LVN nursing license, proof of completing a 24-hour Board of Registered Nursing (BRN) approved DSD course or equivalent college transcripts, personal identification, a full employment history, a description of the training programs you plan to lead, and a comprehensive resume documenting your relevant work experience in healthcare education.
Submission and review: Send your complete packet to the CDPH Licensing and Certification Program office. Incomplete submissions will not be approved. Allow several weeks for review. Once approved, you may begin serving in a DSD or Instructor role at licensed California facilities. Related forms such as the CDPH 278B form and the healthcare practitioner credentialing application may also be required depending on your facility type.
| Question | Answer |
|---|---|
| Form Name | Cdph Dsd Application Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | dsd application form, cdph 279, cdph270, dsd application form 2019 |