Individual And/Or Facility Request For CNA Application

If you are an Individual please provide the following:

1. Name of Individual

2. Address 

3. Telephone number 

4. Type of application desired: Endorsement, Renewal, or Initial application

If you are an Agency please provide the following:

1. Agency Name

2. Address

                    3. Name and title of contact person

4. Telephone No

5. Number of Endorsement applications needed

6. Number of Initial CNA Applications needed

 

Please fax your request to 410-764-8042, or send an e-mail to us, or send a letter to: Maryland Board of Nursing, Nursing Assistant Certification Program, 4140 Patterson Avenue, Baltimore, MD 21215.

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