In the realm of health care education and regulation, the DSHS 14-371 form plays a crucial role. Drafted by the Department of Health together with the Aging and Long-Term Support Administration, this document serves as an application for approval of Nursing Assistant Training Programs (NATCEP) across various health care facilities, hospitals, schools, and other entities. The form captures vital details about the sponsoring institution, including legal names, contact information, and descriptions of the training environments provided. With sections dedicated to classroom and laboratory spaces, the form demands a comprehensive overview of the physical and educational resources available for training purposes. It dives deep into the specifics of the instructional regime, ranging from hours allocated for classroom and clinical instruction to detailed listings of instructors and clinical training facilities. Essential attachments such as program director declarations, instructional staff applications, course objectives, curriculum outlines, and evaluation methods underscore the form's function as a thorough vetting tool designed to ensure that nursing assistant programs meet the rigorous standards set by Washington's administrative code and federal regulations. Through these meticulous requirements, the DSHS 14-371 ensures that aspiring nursing assistants are educated and trained in environments that champion both excellence and compliance.
| Question | Answer |
|---|---|
| Form Name | Form Dshs 14 371 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | 14_371 natcep arizona form |
AGING AND |
DEPARTMENT OF HEALTH |
BUDGET RECONCILIATION PROGRAM |
NURSING ASSISTANT TRAINING |
PO BOX 45600 OLYMPIA WA |
PROGRAM |
FAX |
PO BOX 47852 OLYMPIA, WA |
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FAX |
Nursing Assistant Training Program (NATCEP)
Application for Approval
DATE OF APPLICATION
LEGAL NAME OF SPONSORING HEALTH CARE FACILITY, HOSPITAL, SCHOOL OR OTHER ENTITY |
PHONE NUMBER (WITH AREA CODE) |
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BUSINESS ADDRESS |
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ZIP CODE |
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STREET ADDRESS IF DIFFERENT FROM MAILING ADDRESS |
CITY |
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STATE |
ZIP CODE |
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NAME OF FACILITY ADMINISTRATOR, VOCATIONAL DIRECTOR, DEPARTMENT HEAD OR CHEIF ADMINISTRATIVE OFFICER |
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NAME OF PROGRAM DIRECTOR, NURSING ASSISTANT TRAINING PROGRAM |
CONTACT PHONE NUNBER (WITH AREA CODE) |
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Describe the classroom space allotted to your training program. Specify type of room, square footage,
Describe the training laboratory and the personal care equipment used for the practice of clinical skills. Attach a separate sheet if necessary.
List the teaching resources for the program. For example, name and publication date of textbooks and
Textbooks:
Other (specify):
Number of hours proposed for your Nursing Assistant Training |
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Program: |
Total hours: |
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Classroom |
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Clinical |
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How many clinical hours will be in the facility? |
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How many clinical hours will be in the lab setting? |
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Important: Please read Page 2 of this form.
DSHS
Nursing Assistant Training Program (NATCEP) Application Approval, Page 2
LIST ALL INSTRUCTORS
LIST ALL FACILITIES WHERE CLINICAL TRAINING WILL BE CONDUCTED THROUGH YOUR TRAINING PROGRAM
The following attachments are required for all programs. ATTACH THE FOLLOWING TO THIS APPLICATION.
1. NATCEP Application for Program Director, DSHS
2. Declaration of the Program Director, DSHS
3. Instructional Staff Applications, DSHS
4. A list of course objectives for your training program.
5. The curriculum outline and schedule of class and clinical presentations. The applicant must provide evidence of content that will lead to the achievement of all required nursing assistant competencies listed in Washington Administrative Code (WAC)
6. A sample lesson plan for one core unit of the curriculum outline. This includes a lesson plan objective and any supporting
7. The skills checklist used in your program for skills achievement verification.
8. A description of the evaluation methods and your program requirements for passing. Describe below or use a separate sheet.
9. Copies of the required affiliated agreement with facilities where clinical training is conducted.
10. Sample of student record form to be used by training program.
11.
a.The State Board for Community and Technical Colleges;
b.The Superintendent of Public Instruction; or
c.The Workforce Training and Education Coordinating Board.
DSHS