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Test-Out or Challenge Candidate Application Form 1101 Application

You are considered a test-out candidate or challenge candidate and eligible to apply to take the Minnesota Nurse Aide competency exam for certification as a Nurse Aide in Minnesota if you qualify under one of the following:
- If you trained in another country.
- If you have not taken a nurse aide training program.
- If you have not worked as a nurse aide in the last 24 months.
- If you are from another state and do not qualify for reciprocity in Minnesota or are not in current status on transferring Registry.

Note: If you test in the Infacility Server, you are no longer eligible to test in the MN State Server.

Legal First Name

Middle

Legal Last Name

Birthdate

Phone

SSN

Gender

Male Female Other

Address

City

State

Zipcode

Affidavit

I meet one of the following four criteria:

I have trained in another country.
I have not taken a nurse aide training program.
I have not worked as a nurse aide in the last 24 months.
I am from another state and do not qualify for reciprocity in Minnesota or are not in current status on transferring Registry.

I understand that once I am tested in the Infacility Server I cannot switch servers.

By Submitting

I hereby verify that I understand and agree with the statements contained herein and the above information is true and correct.