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The Certified Nurse Aide course requires a great deal of paperwork to be completed. Some forms are required for the University, some for the State of Alaska and the majority are required for the Ketchikan Medical Center to complete clinicals. Following is a list of the required paperwork:

UAS Ketchikan Campus:

  • Code of Conduct/Student Agreement
  • UAS Drug Policy
  • Pre-Class Questionnaire
  • Course Registration Form (Course fee due at time of registration)

State of Alaska:

  • Application for Certified Nurse Aide by Exam (must be signed in front of a Notary Public)
  • Fingerprints (One set - requires additional cost)

Ketchikan Medical Center:

  • Student Contact Information Sheet
  • Liability Waiver
  • Student Agreement
  • Confidentiality Agreement
  • Code of Ethics
  • HR Policy Manual Review & Quizzes
  • Application for Background Check (KMC form)
  • Disclosure of Personal History & Release of Information Authorization (Alaska DHSS form)
  • Fingerprints with Certificate of Positive ID (Two sets)
  • Health Forms
    • TB (PPD) Test, Tetanus (Tdap) Shot (current within past 10 years) & Annual Influenza Shot must be current
    • Titers (Blood Test for proof of immunizations)
    • Immunization Records
    • Latex Allergy Questionnaire
    • Employee Health Exam Questionnaire
    • Health Care Practitioner Exam (to be completed by your doctor during physical exam)
    • Medical Questionnaire for Respiratory Protection Program

These forms will be reviewed at the Mandatory Orientation Sessions held prior to the start of the course. When packets are complete, please contact Abby Kosmos at (907) 228-4537 to schedule an appointment to review your packet materials.


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