Form DSHS 14 371, also known as the “Food Stamp Application” is a form that is used to apply for food stamps in the state of Washington. The form can be completed online or through a paper application, and it requires basic information about the applicant, such as their name, address, and Social Security number. The form also asks questions about the household’s income and assets, as well as how many people are in the household. Completing this form is the first step in applying for food stamps in Washington. Form DSHS 14 371 is also known as the "Food Stamp Application." It's a form used to apply for food stamps in Washington State. The form can be completed online or through a paper application. Itrequires information about you such as your name, address and social security number; andinformation about your household's income and assets- plus how many members are in yourhousehold. Completing this form is just one step of applying for food stamps here inWashington State!
Question | Answer |
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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 |
CITY |
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COUNTY |
STATE |
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