Submit New Application

Training Program Request Form Application

Please complete this form if you are a California Department of Public Health (CDPH)-approved Training Program and would like to access TMU©. TMU© is the testing software platform that the nurse aide competency evaluation will be conducted through with D&SDT-HEADMASTER.

If you have instructors, please have them fill out the Primary Nurse Aide Training Instructor Login Request Form so we can attach them to the training program.

A training program login will provide you the following:

Ability to pay candidates
Access to training program performance reports
Access to individual instructor performance reports

Once you have completed all of the fields within this application, select “Send Application" to submit your application.

Name

Email

Director of Nursing

Fax

Phone

Alt Phone

Administrator

Approval Number

Address

City

State

Zipcode

Mailing Address

Address

City

State

Zipcode

Additional Facility Information

Discipline Select the discipline type you are applying for.

Parent Facility Select the parent facility for this facility.

Letter of Approval

Please upload your CDPH approval letter

Affidavit

We are a California Department of Public Health (CDPH)-approved Training Program

By Submitting

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