Submit New Application

Idaho MA-C Instructor Application

Complete this form and submit it by selecting 'Send Application'. Once approved, you will receive a login to Idaho TMU where you will enter and complete your students' Idaho MA-C training to allow them to be eligible to take the exam.

Legal First Name

Middle

Legal Last Name

Suffix

Birthdate

Phone

SSN

Gender

Male Female Other

Address

City

State

Zipcode

RN License Information

License Number Enter your license number.

Expires Select your license expiration date.

Training Program Affiliation

Training Program Name Please enter the Training Program name where you work.

Training Program Address Please enter the street address of the Idaho MA-C Training Program. Include the City, State, and Zip in the next fields. This will be used to create the Training Program and will expedite your Instructor application process.

City Please enter the city of the Idaho MA-C Training Program.

State Please select the state (ID) of the Idaho MA-C Training Program.

Zip Code Please enter the zip code of the Idaho MA-C Training Program.

Affidavit

I attest, through this login, I will only enter and complete my candidate's training for the candidates that have met the following criteria as defined in the Idaho State Regulation 54-1406A.

CERTIFIED MEDICATION ASSISTANT:

(a) Is registered as a nursing assistant, without substantiated charges, on the nursing assistant registry currently maintained by the Idaho Department of Health and Welfare,
(b) Has received training preparing for a role in administering medications and works under the supervision of a licensed nurse in a skilled nursing facility,
(c) Has completed an MA-C following the model curriculum approved by the National Council of State Boards of Nursing.

By Submitting

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

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