Form 5513 Natcep PDF Details

The Texas Department of Aging and Disability Services administers the Form 5513-NATCEP, an essential document for Registered Nurse (RN) or Licensed Vocational Nurse (LVN) students seeking to demonstrate their competency in basic nursing skills through the Competency Evaluation Program (CEP) in Texas. This form plays a pivotal role in the approval process, allowing these students to leverage their current or recent educational achievements towards qualifying for the CEP, provided they are enrolled or have been enrolled within the past two years in a state-accredited school of nursing across any state. It meticulously outlines the requirements for eligibility, including an uncompromised status regarding employment eligibility and a clean criminal record, as specified by the Employee Misconduct Registry (EMR) and the Texas Health and Safety Code §205.006. The procedural elements of the application involve a straightforward submission process comprising personal identification details, comprehensive academic records, and necessary declarations by the dean or director of the nursing school. Furthermore, applicants are guided through obtaining a criminal history check from the Texas Department of Public Safety, a prerequisite for the application's approval. Upon successful review, candidates are notified of their eligibility status and provided with the necessary materials to proceed with the Competency Evaluation Program, along with instructions for locating an approved facility for taking the CEP. It emphasizes applicants’ responsibilities in proceeding with the examination process and ensures their right to access and correct personal information collected during the application process, as governed by Texas Government Code Sections 552.021, 552.023, and 559.004. By delineating these procedures and requirements, Form 5513-NATCEP serves as an indispensable tool for nursing professionals in Texas aiming to formalize their competencies and advance their careers.

QuestionAnswer
Form NameForm 5513 Natcep
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other names5513-NATCEP, Disappr, DPS, yyyy

Form Preview Example

Texas Department of Aging and Disability Services

Nurse Aide Training Program

Request to Take the Competency Evaluation Program (CEP)

Based on Competency in Basic Nursing Skills

as an RN/LVN Student

Form 5513-NATCEP

May 2008

I.Use this form to request approval to take the CEP in Texas if you:

•are currently enrolled or have been enrolled within the past two years in a state accredited school of nursing in any state,

•have demonstrated competency in providing basic nursing skills in accordance with the school’s curriculum, and

•meet CEP requirements listed at §94.9(c)(2)-(3) of the Licensing Standards for Nurse Aides. No individual listed as unemployable on the Employee Misconduct Registry (EMR) or who has been found to have a conviction of a criminal offenses listed in Texas Health and Safety Code §205.006 will be eligible for the CEP. Chapter 250 and a list of convictions can be found at: http://tlo2.tlc.state.tx.us/statutes/hs.toc.htm.

Nurse Aide Training Program staff will complete the EMR check. However, individuals requesting to take the CEP must request a criminal history check from the Texas Department of Public Safety (DPS). For instructions on how an individual can obtain a criminal history check, contact your local DPS office or visit the website: www.txdps.state.tx.us/administration/crime_records/pages/faq.htm. You must submit your criminal history results along with this application to receive approval to take the test.

II.Complete Items A through O (type or fill out electronically). A. Name (Last, First, Middle)

B.

Maiden Name

C. Other Surnames

 

 

 

 

D.

Social Security No.

E. Date of Birth (mm/dd/yyyy)

 

 

 

 

F.

Address (Street, City, State, ZIP Code)

 

 

 

 

 

G.

Home Area Code and Telephone No.

H. Daytime Area Code and Telephone No.

I.Name of Facility, if employed

J.Address of Facility (Street, City, State, ZIP Code)

K.Name of School

L.Address of School (Street, City, State, ZIP Code)

M.Date Enrolled (mm/dd/yyyy)

N. Signature

O. Date (mm/dd/yyyy)

III.Dean or director of the school of nursing must complete Items P through V and have a notary complete W.

P.Is the school or college of nursing listed below accredited by the state?.................................................

Q.Has this applicant demonstrated competency in providing basic nursing skills in accordance with the school’s curriculum?................................................................................................................................

R.Dates Attended School of Nursing (mm/dd/yyyy)

From:To:

S. Name of School or College

Yes

Yes

No

No

T. Address (Street, City, State, ZIP Code)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Form 5513-NATCEP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Page 2/05-2008

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

U. Signature – Dean or Director

 

 

 

 

 

 

 

 

 

 

 

 

 

 

V. Date

 

 

Title:

 

 

 

 

 

 

Telephone:

–

–

 

W. TO THE STATE OF

 

 

 

 

 

)

 

 

 

 

 

 

 

COUNTY OF

 

 

 

 

 

)

 

 

 

 

 

 

 

BEFORE ME, the undersigned authority, on this day personally appeared

 

 

 

 

 

,

known to me to be the person whose name is subscribed to the foregoing instrument, and having been by me first duly

 

sworn on oath, acknowledged that he or she has executed the same for the purposes and considerations therein

 

expressed and that the foregoing statements are true and correct.

 

 

 

 

 

GIVEN under my hand and seal of office, this

 

 

day of

 

 

 

20

 

,

notary public in and for

 

 

 

 

 

County, Texas or

 

 

 

 

 

.

Signature – Notary

AFFIX NOTARY STAMP

 

Name – Notary

OR SEAL HERE

 

 

 

 

 

Date Commission Expires

IV. The Department of Aging and Disability Services (DADS) will review your request and send you a written notice of approval, deficiency or disapproval. When you are approved, you will receive a:

•letter stating eligibility to take the CEP,

•copy of the skills checklist, and

•test application and instructions.

V. You are responsible for finding a location to take the CEP. If possible, find:

•an approved facility that offers you employment and testing, or

•an approved facility or nurse aide training program that volunteers to test you.

Visit our website, www.dads.state.tx.us/providers/NF/credentialing/, to help locate a training program near your area.

VI. Return completed form to:

 

 

 

 

 

 

Department of Aging and Disability Services

 

 

 

 

 

 

Nurse Aide Training Program

 

 

 

 

 

 

Mail Code: E-420

 

 

 

 

 

 

P.O. Box 149030

 

 

 

 

 

 

Austin, Texas

78714-9030

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DADS Office Use Only

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Rev on

 

by

 

Disappr on

 

by

 

 

 

 

 

 

 

 

 

 

 

Inc on

 

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Disappr sent on

 

by

 

 

 

 

 

 

 

 

 

 

 

Inc sent on

 

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Appr on

 

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Appr sent on

 

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Disappr on

 

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Department of Aging and Disability Services

Nurse Aide Training Program

P.O. Box 149030

Mail Code E-420

Austin, Texas 78714-9030

credential@dads.state.tx.us

With a few exceptions, you have the right to request and be informed about the information that the Department of Aging and Disability Services (DADS) obtains about you. You are entitled to receive and review the information upon request. You also have the right to ask DADS to correct information that is determined to be incorrect (Government Code Sections 552.021, 552.023, 559.004). To find out about your information and your right to request correction, please contact the Long Term Care-Regulatory Nurse Aide Training Program at 512-438-2017.

How to Edit Form 5513 Natcep Online for Free

Once you open the online editor for PDFs by FormsPal, you can easily fill in or edit E-420 right here and now. In order to make our tool better and more convenient to use, we consistently implement new features, taking into account suggestions coming from our users. With a few simple steps, you may start your PDF journey:

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Step 2: As soon as you open the tool, you'll notice the document made ready to be completed. Aside from filling out different blanks, you could also do other sorts of actions with the PDF, such as adding any text, editing the initial textual content, adding graphics, putting your signature on the document, and a lot more.

For you to complete this form, be certain to type in the information you need in each blank field:

1. The E-420 requires certain details to be entered. Ensure that the subsequent blanks are finalized:

LVN conclusion process clarified (step 1)

2. After performing the previous part, go to the subsequent part and fill out the essential details in all these fields - M Date Enrolled mmddyyyy, N Signature, O Date mmddyyyy, III Dean or director of the school, P Is the school or college of, Q Has this applicant demonstrated, schools curriculum, Yes, Yes, R Dates Attended School of Nursing, From, S Name of School or College, and T Address Street City State ZIP.

Step # 2 for filling out LVN

3. This 3rd segment is relatively straightforward, U Signature Dean or Director, V Date, Title, Telephone, Form NATCEP Page, W TO THE STATE OF, COUNTY OF, BEFORE ME the undersigned, known to me to be the person whose, GIVEN under my hand and seal of, day of, notary public in and for, County Texas or, AFFIX NOTARY STAMP, and OR SEAL HERE - every one of these form fields has to be filled in here.

LVN conclusion process shown (portion 3)

Be really attentive when completing V Date and OR SEAL HERE, since this is where many people make a few mistakes.

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