Mi Prometric Details

Candidates seeking to renew their certification through Prometric are required to complete a renewal form. The form can be found on the Prometric website, and is available in both English and Spanish. The process is relatively simple, and takes only a few minutes to complete. In order to renew your certification, you must have completed at least 12 contact hours in the past two years. Continuing education credits can be earned by attending workshops, training seminars, or conferences; by reading professional journals and articles; or by completing online courses. The Prometric Cna Renewal Form is an important document that must be completed in order to keep your certification current. Make sure you allow enough time to complete the renewal process before your certification expires.

Here is the data concerning the PDF you were in search of to fill out. It will tell you the length of time you will require to complete prometric cna renewal, what parts you will need to fill in, a

QuestionAnswer
Form NamePrometric Cna Renewal
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namescna renewal michigan, prometric renewal form, prometric cna renewal michigan, prometric michigan

Form Preview Example

* R E N E W A L C N A M I *

Michigan Nursing Assistant

Registry Renewal Form

Instructions:

Please go to www.prometric.com/NurseAide/MI to print the current version of this application and all other forms. DO NOT submit photocopies as this may impact the ability to process the application. Incomplete, blurred or illegible forms will not be processed.

Please complete all of the information requested on this form, including the employer information on Page 2 of this form. Failure to fully complete all pages may result in delays or denial of the renewal of your certification.

Please mail completed original forms to Prometric, ATTN: MI Nurse Aide Registry Renewal, 7941

Corporate Drive, Nottingham, MD 21236.

If your legal name has changed since last communication with Prometric, 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.

Eligibility for Renewal

You are eligible to renew your certificate if you have worked as a nursing assistant performing nursing or nursing- related services to a patient or resident for pay for at least eight consecutive hours within the immediate 24-month period prior to your current registry document expiration date. Nursing assistants with employment restrictions on the registry for resident abuse, neglect, misappropriation of resident property or criminal record disqualifications are not eligible for renewal.

Nursing Assistant Information

All fields marked with * are required. Print one number/letter in each box where required.

*Social Security Number --

*First Name

Middle Initial



*Last Name



*Date of Birth (Month/Day/Year)

//

Previous name (if applicable):

*Street Address (including Apt. number or P.O. Box, if applicable)

*City

*State  * ZIP Code 

*County (first four letters only)

 

Daytime Phone Number (including area code)

 

 

--

*Email Address (form will not be processed without an email address)

RENEWALCNAMI

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Rev. 01292019

Employment Information

Please complete the following section with your current or previous employer information.

*Name of Employer

*Address of Employer (Street Address or P.O. Box)

*City

 

*State

*Zip Code

 

 

Date of Hire: (MONTH/DAY/YEAR): ____________________________________

 

Are you currently employed at the facility listed above?

Yes

No

 

If No, Date of Termination: (MONTH/DAY/YEAR): ______________________________

 

 

 

 

 

Nursing Assistant Attestation and Signature

I certify that the information put forth on this Michigan Nursing Assistant Registry Renewal Form is true and correct to the best of my knowledge.

I understand that if I have given false information in this application, my nurse aide certification may be invalidated and I could be prosecuted by the state of Michigan.

Signature of Nursing Assistant (in box below)

Date: ______________________

Questions: For additional information, please visit our website at www.prometric.com/nurseaide.

Please make a copy of all completed forms for your personal records.

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* P A Y C N A M I *

Payment Form

*Candidate Name: _____________________________________

*Date of Birth: ______________________

Credit Card Type (Check One)

 

 

 

MasterCard

Visa

American Express

 

 

 

 

 

 

 

Card Number

 

 

Expiration Date

 

 

 

 

/

 

Amount

 

 

C/C Security Code

$ __ __ __ . __ __



 

 

 

 

 

Name of Cardholder (Print)

Signature of Cardholder

Certified Check or Money Order Payments

Certified Check

3rd Party/Facility Check

Money Order

Certified Check/Money Order/3rd Party/Facility Check Number (one number or letter in each box):



Fee(s) may be paid by money order or certified check made payable to Prometric. Your name and ID (if available) must be written on the form of payment. Personal checks and cash are not accepted. Fees are non-refundable and non-

transferrable.

Please mail this completed form, any required documentation and $20 non-refundable processing renewal fee

in the form of a money order, certified check or American Express, Visa or Mastercard to:

Prometric

Attn: Michigan Nurse Aide Registry Renewal

7941 Corporate Drive

Nottingham, MD 21236

PAYCNAMI

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Rev. 01292019