4140 Patterson Avenue - Baltimore, Maryland 21215-2254
Toll Free: 1 (888) 202 – 9861 • Phone: (410) 585 – 1900 • TTY/TDD: 1 (800) 735 – 2258
Fax: (410) 358 - 3530
www.mbon.maryland.gov
Rev. 11/2020
Board of Nursing
Larry Hogan, Governor ∙ Boyd K. Rutherford, Lt. Governor Robert R. Neall, Secretary
Memorandum
TO: CNA/GNA Training Program Approval Applicants
FROM: The Maryland Board of Nursing
RE: Application for Approval of a Nursing Assistant Training Program
To assist your Nursing Assistant Training Program renewal process; enclosed is an application for Program
Approval from the Maryland Board of Nursing. Also included are instructions for completing the application
accompanied with an Approval Grid and a Resource Packet. Please follow the instructions, closely, when you
complete your application.
All CNA/GNA Training Programs must be approved by the MBON, NPA, §8-6-14; “The Board, in conjunction with
the Maryland Higher Education Commission, shall approve each nursing assistant training program prior to its
implementation and provided periodic survey of all programs in the State.” The Board reviews programs for initial
approval and renewal on a monthly basis. Applications received by the 1
st
of the month will be submitted at that
month’s regularly scheduled board meeting.
Please note that documentation of approval or waiver/exemption from the Maryland Higher Education Commission
is also required before your program can be reviewed (see application packet). If you are a college you are not
required to submit this documentation.
A thoroughly completed application accompanied by the required documents will progress approval and renewal of
your program. Please submit your information electronically as a PDF and scan your documents in the order
requested on the application. No faxed documents will be accepted. Please send your completed application to:
Thank you for your assistance in helping the MBON meet its mission: to advance safe, quality care in Maryland
through licensure, certification, education, and accountability for public protection.
Joyce Cleary, BSN, RN
Education Consultant
Phone: 410-585-1946
4140 Patterson Avenue - Baltimore, Maryland 21215-2254
Toll Free: 1 (888) 202 – 9861 • Phone: (410) 585 – 1900 • TTY/TDD: 1 (800) 735 – 2258
Fax: (410) 358 - 3530
www.mbon.maryland.gov
Rev. 11/2020
Board of Nursing
Larry Hogan, Governor ∙ Boyd K. Rutherford, Lt. Governor ∙ Robert R. Neall, Secretary
APPLICATION
Certified Nursing Assistant
Training Program Approval
4140 Patterson Avenue - Baltimore, Maryland 21215-2254
Toll Free: 1 (888) 202 – 9861 • Phone: (410) 585 – 1900 • TTY/TDD: 1 (800) 735 – 2258
Fax: (410) 358 - 3530
www.mbon.maryland.gov
Rev. 11/2020
Board of Nursing
Larry Hogan, Governor ∙ Boyd K. Rutherford, Lt. Governor ∙ Robert R. Neall, Secretary
APPLICATION FOR APPROVAL
1. General Information (Please type or print all entries):
This Application is for: Certified Nursing Assistant Training ___ Geriatric Nursing Assistant Training ___
(Check one or both.)
____________________________________________________________________________________________
1a. Name of Program Provider/Organization
____________________________________________________________________________________________
1b. Address
__________________________________________ (______)_________________ (______)________________
1c. Contact 1d. Telephone 1e. Fax
1f. Job Title: ______________________________ 1g. Email Address: ________________________________
2. Program Information
2a Please check: New Program _______ Program Renewal _______ Change in Existing Program _______
2b. Except for Programs in Maryland Colleges, has this Program received approval or waiver
by the Maryland Higher Education Commission? Y ___ N ___
A copy of MHEC approval or waiver must accompany this Application (except for MD College Program).
2c. Does this program accept any students who pay their own tuition? Y ___ N ___
2d. Total Number of: Course Hours: _____ Classroom Hours: ____ Lab Hours_____ Clinical Hours: ______
(60 hours minimum should be devoted to classroom instruction, 16 hrs. minimum should be lab instruction, and
40 hours minimum of clinical training in a clinical facility.)
2e. For renewals include the Program’s Code: ________________
2f. Name/ Location of Education (Classroom) Facility: Name/ Location(s) of Clinical Facility:
___________________________________________ ____________________________________________
___________________________________________ ____________________________________________
4140 Patterson Avenue - Baltimore, Maryland 21215-2254
Toll Free: 1 (888) 202 – 9861 • Phone: (410) 585 – 1900 • TTY/TDD: 1 (800) 735 – 2258
Fax: (410) 358 - 3530
www.mbon.maryland.gov
Rev. 11/2020
___________________________________________ ____________________________________________
Attach Addendum if more than one location is used.
2g. Name of Program Director/Coordinator: _____________________________________________________
Signature of Program Director/Coordinator: _____________________________________________________
Telephone Number: __________________________ Date of Application Submission: __________________
For each of the following regulations check Y if your program conforms or N if it does not conform:
3. .04 Administration and Organization
3a. The facility offering the training program shall be accredited/approved by the appropriate agency. Y __ N ___
3b. Name of Approving Agency: _________________________________________________________________
3c. The facility that offers the training program shall have a statement of equal opportunity employment. Y __ N __
3d. Does the controlling institution provide financial support/resources needed to operate a
CNA Training Program which meets legal and educational requirements of the Board?
Example; adequate educational facilities, equipment, and qualified administrative personnel Y ___ N ___
* Attach Addenda: Statements of Agency Approval, Facility Equal Opportunity, Financial Support
4. .05 Faculty
4a. Each instructor shall be a registered nurse licensed to practice in Maryland. Y ___ N ___
4b. Each instructor shall have a minimum of two (2) years nursing experience. Y ___ N ___
4c. Each nurse shall have at least one (1) year experience in caring for the elderly or chronically ill
in the past five (5) years.
4d. Each instructor shall complete a minimum sixteen (16) hours of instruction in the
Y ___ N ___
Principles of Adult Education, or have a minimum of 2 years of teaching experience.
4e. The program shall have an RN instructor who has overall supervisory responsibility for
Y ___ N ___
the operation of the program.
Y ___ N ___
4f. Does your program utilize Adjunct Faculty. (Not a requirement)
Y ___ N ___
4g. Job description/Policy shall demonstrate 10.39.02.05.D-5 for faculty responsibilities.
Y ___ N ___
4h. List all Nursing Faculty:*
____________________________________ Program Coordinator __ Class Instructor __ Clinical Instructor __
Name/ License Number (Check all that apply.)
4140 Patterson Avenue - Baltimore, Maryland 21215-2254
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Fax: (410) 358 - 3530
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Rev. 11/2020
____________________________________ Program Coordinator __ Class Instructor __ Clinical Instructor __
Name/ License Number (Check all that apply.)
____________________________________ Program Coordinator __ Class Instructor __ Clinical Instructor __
Name/ License Number (Check all that apply.)
____________________________________ Program Coordinator __ Class Instructor __ Clinical Instructor __
Name/ License Number (Check all that apply.)
*Attach Addendum if there are more than four (4) Nursing faculty members.
*Attach Addenda: Instructor Resume(s), Train the Trainer Certificate(s) if applicable, Copy of Maryland RN
License(s), Faculty Job Description/Policy Statement Describing Faculty Responsibilities, List of Adjunct
Faculty if applicable.
5. .06 Resources, Facilities, and Services
5a. The physical facilities shall be adequate to meet the needs of the training program and shall include the
following:
Adequate space for privacy of faculty-student conferences: Y ___ N ___
Classroom(s): Y ___ N ___
Skills Lab(s): Y ___ N ___
Conference Room(s): Y ___ N ___
Sufficient Equipment for Numbers of Students: Y ___ N ___
Space for Equipment/Instructional Materials: Y ___ N ___
5b. All learning resources such as books, A-V Materials, and Computer Programs shall have the following:
Current and have a publication date not older than 5 years.
Y ___ N ___
Accessible to students:
Y ___ N ___
Relevant to the Curriculum
Y ___ N ___
Written at a level appropriate for Nursing Assistants
Y ___ N ___
Are selected with the participation of the Nursing Faculty
For GNA programs only: Each student shall receive a copy of the
Y ___ N ___
GNA Candidate Handbook from at the beginning of the program.
5c The Facilities used for clinical training experience shall:
Students providing services to residents shall be under the general supervision
Y ___ N ___
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Rev. 11/2020
of an LPN or RN (42 CFR 483.152).
Y ___ N ___
Be approved by the appropriate government authorities. Ex; DHMH license.
The facilities with conditional/provisional approval status may not be used for student.
Y ___ N ___
learning experience.
Y ___ N ___
The Board must approve the clinical facility before utilization of student experience.
Y___ N___
A minimum of one instructor for each eight students (1 to 8) in the clinical area.
Y ___ N ___
A sufficient number/variety of clients to provide training experiences to achieve objectives. Y ___ N ___
Shall have a sufficient number of RNs/other Nursing personnel to ensure safe and
continuous care of clients: Y ___ N ___
Shall conform with accepted standards of nursing care/practice: Y ___ N ___
5d. The Training Program shall have a Written Agreement with the Clinical Facility (ies)? Y ___ N ___
*Attach Addenda: Description of Education Facility & Equipment, Description of Clinical Facility(ies) with
Statement of Approval, copy of Written Agreement or Contract if applicable, and Completed Description of
Instructional Materials Form.
6. .07 Training Program
6a. Instructions: Provide page numbers on submitted curriculum. Provide the page number on this application
where the following required content areas are found:
The training program shall provide a minimum of 100 hours. 60 hours should be devoted toward didactic
training and 40 toward clinical training in a clinical facility. The following content shall form the
framework of the curriculum:
Curriculum Content Area
Page
Role of the Certified Nursing Assistant
Infection Control
Safety/Environment
Mobility/Positioning
Elimination
Data Collection
Hygiene
Treatments
Communication
*Observing, recording, reporting
4140 Patterson Avenue - Baltimore, Maryland 21215-2254
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Fax: (410) 358 - 3530
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Rev. 11/2020
*Interpersonal Relations
Legal/Ethical Considerations
Basic Anatomy/Physiology
Basic Human Needs/Hierarchy
Growth & Development
Medical Terminology/Abbreviations
Measurements
Basic Math
Disease Process: Acute vs. Chronic
Basic Nutrition
Activity of Daily Livings
CPR
Heimlich Maneuver/Abdominal Thrust
6b. Instructions: Provide a course overview with the hours each subject is taught and demonstrate that these
subjects below are presented to the student BEFORE the clinical training experience occurs.
A training program shall provide at least 16 hours of classroom Laboratory training before a trainee’s
direct assignment to client care. This instruction shall include the following topics:
Content Area/ 16-Hour Pre-Clinical
Role of the C.N.A.
Infection Control
Safety and Environment; Emergency procedures including the Heimlich Maneuver
Mobility and Positioning
Elimination
Data collection
Hygiene
Treatments
Communication: Observing, recording, reporting Interpersonal relations
Legal/Ethical Considerations
*Attach Addendum: Course Schedule With Highlighted Pre-Clinical Requirements.
4140 Patterson Avenue - Baltimore, Maryland 21215-2254
Toll Free: 1 (888) 202 – 9861 • Phone: (410) 585 – 1900 • TTY/TDD: 1 (800) 735 – 2258
Fax: (410) 358 - 3530
www.mbon.maryland.gov
Rev. 11/2020
6c. Instructions: Provide a Skills Inventory Checklist used to evaluate student performance. Check below that the
following required Maryland Skills Listing is included on your comprehensive skills inventory.
Students must not perform any services for which they have not trained and been found proficient by the
instructor. 42 CFR 483.152
PROVIDE A LIST OF LAB EQUIPMENT THAT WILL BE USED TO INSTRUCT IN THE FOLLOWING
REQUIRED SKILLS:
1. ____ Hand Hygiene
2. ____ Measures/Records weight
3. ____ Provide Oral Hygiene
4. ____ Dresses Client w. Affected Arm
5. ____ Transfers Client from Bed to Wheelchair
6. ____ Assists Client to Ambulate
7. ____ Cleans/Stores Dentures
8. ____ Performs Passive ROM for Shoulder
9. ____ Performs Passive ROM for Knee/Ankle
10. ____ Measures/Records Urinary Output
11. ____ Assists Clients w. Use of Bedpan
12. ____ Provides Perineal Care to Incontinent Client
13. ____ Provides Catheter Care
14. ____ Takes/Records Oral Temperature
15. ____ Takes/Records Pulse/Respirations
16. ____ Takes/Records BP (1-Step procedure)
17. ____ Takes/Records BP (2-Step procedure)
18. ____ Puts Knee-High Stockings On
19. ____ Makes an Occupied Bed
20. ____ Provides Foot Care
21. ____ Provides Fingernail Care
22. ____ Feeds Client Who Cannot Feed Self
23. ____ Positions Client on Side
24. ____ Gives Modified Bed Bath
25. ____ Shampoos Client’s Hair in Bed
*Attach Addendum: Skills Inventory With Required Maryland Skills Listing Highlighted.
*Federal Regulations for curriculum 42 CFR 483.152(b)
6a. Instructions: Provide page numbers curriculum is located on the submitted curriculum.
The curriculum of the nurse aide training program must include:
Regulation
Page
Caring for the Resident When Death is Imminent
Mental Health and Social Service Needs
Modifying Aide’s Behavior in Response to Residents’ Behaviors
Allowing the Resident to make Personal Choices
Care for the Cognitively Impaired including, Techniques for
Addressing the unique Needs and Behaviors of the
Alzheimer’s/Dementia Resident
Communicating with the Cognitively Impaired Resident
Understanding the Cognitively Impaired Resident
Appropriate Responses to the Cognitively Impaired Resident
Methods of Reducing the effects of Cognitive Impairment
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Fax: (410) 358 - 3530
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Rev. 11/2020
Basic Restorative Services
Promoting the Residents’ Independence and Right to Make Choices
Recognizing Abnormal Changes in Body Functioning and the
Importance of Reporting Such Changes to the Supervisor.
Awareness of Developmental Tasks Associated with the Aging Process
How to Respond to Residents’ Behaviors
Using the Resident’s Family for Emotional Support
Providing Privacy and Confidentiality to the Resident
Giving Assistance in Resolving Grievances and Disputes
Maintaining Care and Security of Residents’ Possessions
Avoiding the need for Restraints; According to Professional Standards
*Attach Addendum with the Curriculum; Pages Numbered.
7. .08 Student Evaluation
7a. Does your program have a policy/statement regarding student evaluation/grading/successful
program completion criteria? Y ___ N ___
7b. Does your program have a comprehensive written Final Examination? Y ___ N ___
7c Does your program have a comprehensive evaluation tool for skill assessments? Y____ N___
7d. Does your program have an ACHIEVEMENT AWARD? Y ___ N ___
7e. Does the ACHIEVEMENT AWARD follow the Sample/Guidelines in the Resource Packet? Y ___ N ___
*Attach Addenda: Student Evaluation Criteria, the Final Examination with answer key, and a copy of The
Achievement Award.
Assemble all of the required documents along with the Application Form.
Send the completed Application Packet to the Maryland Board of Nursing in the following order:
1. _____ Cover Letter
2. _____ Approval Grid
3. _____ Application Form
4. _____ Statement of MHEC Approval/Waiver
5. _____ Statements of Agency Approval,
6. _____ Facility Equal Opportunity Employment Statement
7. _____ Statement of Financial support
8. _____ Instructor Resume(s)
4140 Patterson Avenue - Baltimore, Maryland 21215-2254
Toll Free: 1 (888) 202 – 9861 • Phone: (410) 585 – 1900 • TTY/TDD: 1 (800) 735 – 2258
Fax: (410) 358 - 3530
www.mbon.maryland.gov
Rev. 11/2020
9. _____ Train The Trainer Certificate(s) If Applicable
10. _____ Copy of Faculty Maryland RN License(s)
11. _____ Faculty Job Description/Policy Statement Regarding Job Responsibilities
12. _____ List of Adjunct Faculty If Applicable
13. _____ Description of Education Facility & Training Equipment
14. _____ Description of Clinical Facility With Statement of Approval
15. _____ Copy of Written Agreement Between Facilities If Applicable
16. _____ Completed Description of Instructional Materials Form
17. _____ Curriculum; Pages Numbered
18. _____ Course Schedule that contains the number of hours spent on each subject, classroom, and clinical
training. Demonstrate the 16-Hour Curriculum that is taught before the clinical training.
19. _____ Skills Inventory With Required Maryland Skills Listing Highlighted
20. _____ Student Evaluation Criteria
21. _____ Final Examination with skills’ final exam
22. _____ Achievement Award
This Application and addendums must be submitted electronically as a PDF. Incomplete applications will not be
approved by the Board. All unapproved program documents are discarded within one (1) year. Programs with a
previous denial of approval must file a complete NEW APPLICATION for reconsideration.
Maryland Board of Nursing
APPLICATION FOR APPROVAL OF A NURSING ASSISTANT PROGRAM
Description of Instructional Materials
All textbooks and clinical resources shall have a publication date not older than 5 years from current year.
Title
Author/Editor
Publisher
Date
II. AV Resources/Computer Programs
Title
Resource Description (Film,
Video, Computer Program, Etc.)
Producer/Company/Series
Date
Rev. 7/20/2016
Certified Nursing Assistant Training Program - Resource Rev. 7/20/2016
INSTRUCTIONS
For completing the Application for
CNA Training Program Approval
The Application Form must be completed and submitted electronically as a PDF. The required supporting documents must
accompany the Application in the subject order as requested. Contact mbon.cnatrainingprogra[email protected] with
questions regarding these instructions.
1. General Information
1a-1e. Provide the name of the training program provider, the address, contact person regarding the program, telephone,
and fax numbers.
2. Program Information
2a. Indicate whether this is a new program, program renewal, or a change in an existing program.
2b. Except for Maryland College Programs, please indicate whether or not your program has received MHEC approval
or waiver. A copy of the Approval or Waiver must accompany all applications.
2c. Indicate whether or not your program has any students paying for his/her own tuition.
2d. Indicate the total number of Course Hours for each subject in the didactic portion of training including the hours spent
with lab instruction. Include the hours of clinical training as well. Please refer to regulation .07, A, B, C. The
training program shall provide a minimum of 100 hours of instruction. Of the l00 hours a minimum of 60 hours
shall be devoted to classroom instruction and classroom laboratory practice and 40 hours shall be devoted to
clinical training experience in an (Board approved) clinical facility. A Training Program shall provide at least 16
hours of classroom laboratory experience before a trainee’s direct assignment to patient care.
2e. Include the Program Code provided by the Board of Nursing if available/applicable.
2f. Include the name and address of the Education Facility and the Clinical Facility. If more space is required for more
than one location you may attach an Addendum behind page 1 of the Application Form.
2g. Provide the name of the Program Director/Coordinator. This may be the same person as identified above in 1c,
Please provide signature, telephone number, and date of the submitted Application Form.
3.04 Administration and Organization
3a-3b Indicate whether or not the facility offering the program is approved by the appropriate government agency. Provide
the name of the approving agency in 3b. See COMAR, 10.39.02.04.A-1. The facility offering the program must be
accredited or approved by the appropriate agency.
3c. Indicate whether or not the facility offering the Training Program has an Equal Opportunity Employment Statement
as required in COMAR 10.39.02.04.A-2.
3d. Indicate whether or not the facility can provide the financial support/resources as needed to operate a program which
meets the legal and educational requirements of the Board and fosters achievement of program objectives.
Certified Nursing Assistant Training Program - Resource Rev. 7/20/2016
COMAR, 10.39.02.04.B. When providing the required financial statement, include evidence that demonstrates the
financial resource shall provide an adequate:
1. Number of instructors adequate to ensure that each trainee is provided with
2. Classroom instruction and clinical experience learning that will foster achievement of program
objectives;
3. Educational facilities, appropriate equipment, and qualified administrative personnel.
COMAR10.39.02.04.C:
Supporting Documentation Required For Section 3. 04: Statements of Agency Approval, Facility Equal Opportunity
Statement of Employment, and Financial Support.
4. .05 Faculty
4a. Indicate whether or not each faculty member is an RN licensed to practice in Maryland.
COMAR, 10.39.02.05, A-1
4b. Please indicate whether or not each faculty member has the required experience of two (2) years nursing experience;
at least one (1) year of which must have been caring for the elderly or chronically ill in the past five (5) years. For
GNA approval only, one (1) year of this practice must have been in Long Term Care. COMAR, 10.39.02.05, A-2.
4c. Indicate whether or not each faculty member has completed a minimum 16-hours course of instruction in principles
of adult education, Train the Trainer, or has had a minimum of two (2) years nursing- related teaching nursing
experience.
4d. Indicate whether or not your program utilizes Adjunct Faculty. Other health professionals may teach selected
portions of the curriculum that relate to the health professionals’ area of expertise, COMAR, 10.39.02.05.E
4e. Indicate whether or not your facility has a Job Description and/or Policy Statement describing faculty
responsibilities.
COMAR, 10.39.02.05.D, 1-5. Responsibilities for the course instructor are
1. Participate in development and evaluation of the training program
2. Implement the approved training program
3. Supervise classroom laboratory experience
4. Evaluate student performance in the classroom
5. Provide supervision and clinical evaluation of each trainee at the clinical training site.
4f. Please list all Nursing Faculty members. Check all roles that may apply: Program Coordinator,
Class Instructor, and/or Clinical Instructor. If more space is needed, please attach an Addendum and place
following on page 2 of the Application.
Supporting Documentation Required For Section 4. .05: Faculty Resume(s) INDICATE ON THE RESUME WHETHER OR
NOT THERE ARE ANY LIMITATIONS IMPOSED ON THE LICENSE(s) submitted., Train the Trainer Certificate(s) if
applicable, Copy of Maryland RN license(s), Faculty Job Description/Policy Statement describing Faculty
responsibilities , and list of Adjunct Faculty if applicable.
5. .06 Resources, Facilities, and Services:
5a.Indicate whether or not the Training Facility has adequate space for privacy of faculty student conferences,
classroom(s), Skills Lab(s), Conference Room(s), sufficient equipment/supplies for number of students, and
space for equipment/ instructional materials.
5b. Indicate whether or not all resources such as books, A-V materials, and/or computer programs have a publication
date of not older than FIVE years, are accessible to students, are relevant to the Curriculum and are written at a
Certified Nursing Assistant Training Program - Resource Rev. 7/20/2016
level appropriate to Nursing Assistants. The resources must be selected with the participation of the Nursing
faculty.
5c.Indicate whether or not the clinical facility is approved by the appropriate government agency. See COMAR,
10.39.02.06.C, 1-3; “Facilities used for clinical learning experiences shall be approved by appropriate
government authorities. Facilities with conditional or provisional approval may not be used for student learning
experiences. The Board shall approve each facility before utilization of each student experience.
5d.Indicate the required 1:8 Faculty/student ratio in the clinical area.
5e.Indicate whether or not the clinical facility has a sufficient number/variety of clients to provide meaningful training
experience, a sufficient number of RNs/other care givers to ensure safe and continuous care of clients, and that
the facility conforms with accepted standards of nursing care/practice.
5f. Indicate whether or not the Training Program requires a Written Agreement with the clinical facility. COMAR,
10.39.02.06.6a-b, I-V: The training program shall have a written agreement with any clinical facility that is not
a part of the controlling institution.
Supporting Documentation Required for Section 5 .06: Description of Education Facility (address the requirements of the
regulations), Description of the Clinical Facility (address the regulation requirements above), provide a copy of the Written
Agreement if applicable, and complete the provided Description of Instructional Materials Form.
6. .07 Training Program
6a. Prepare your Curriculum with page numbers. Indicate the page number where each required subject is located. All
required components must be addressed in the curriculum; including Core Knowledge & Skills, Emergency
procedures (Heimlich Maneuver), and CPR certification. The Curriculum should utilize the Board’s Training
Guidelines: Learning Objectives and Performance Indicators available on the MBON website.
6b. Please Note: COMAR 10.39.02.07.C,-2: A training program shall provide at least 16-hours of classroom
laboratory before a trainee’s direct assignment to the clinical care. Indicate when these 16-hours of required
content areas are being taught. The hours shall be demonstrated by providing of a Course Schedule with the
application. This instruction shall include the following topics: Role of CNA, Infection control, Safety and
emergency procedures including Heimlich maneuver, the environment, communication (including; observing
recording, reporting and interpersonal relationships), and legal and ethical relations.
6c. Please check the required Maryland Skills List contained within your Skills Inventory (Checklist). A sample Skills
Inventory has been provided in the Resource Packet.
Supporting Documentation Required for Section 6 .07; Training Program:
A copy of the Curriculum, with the Course Schedule and Skills Inventory.
The Curriculum must:
1. Contain all of the required content areas.
2. Provide all the learning objectives and performance indicators.
3. Course Schedule must demonstrate when the 16-hour pre-clinical core is presented.
4. Demonstrate the required 100 hours (60/40 Ratio).
5. The Skills Inventory must contain all the required skills from the Maryland Skills Listing and
shall indicate specific performance indicators that are tested and demonstrated.
7. .08 Student Evaluation
Certified Nursing Assistant Training Program - Resource Rev. 7/20/2016
7a. Indicate whether or not your program has a policy/statement regarding student evaluation/grading/
successful program completion criteria.
7b. Indicate whether or not your program has a comprehensive written Final Examination and skills examination. As
required by COMAR, 10.39.02.08.
7c. Indicate whether or not your program has an ACHIEVEMENT AWARD.
7d. Indicate whether or not Guidelines for the ACHIEVEMENT AWARD found in the Resource Packet have been
adhered.
Supporting Documents Required For Section 7. .08: Student Evaluation criteria, the Final Written and skills Examination,
along with the Achievement Award.
Final Checklist: Indicate the required documentation provided with your Application. The Application documents must be
submitted electronically as a PDF IN THE ORDER requested, with pages numbered.
Thank you for your assistance in helping the MBON meet its mission: to advance safe, quality care in Maryland through
licensure, certification, education, and accountability for public protection.
For Assistance Contact:
Jill Callan, RN
Nurse Program Consultant
Email: mbon.cnatrainingprogram@maryland.gov
Ph: 443-401-7732
Nursing Assistant Training Programs
Application Approval Grid
Facility: __________________________________ Location: ___________________________________________
Contact Person: ____________________________ Telephone: _______________Date Submitted: _____________
Instructions: This Grid will assist the applicant in filing a comprehensive initial /renewal application. Complete
the grid after you have assembled the required documents and return with your application and documents.
.01-.04: MHEC Approval/Waiver, Facility Approval, EOE Statement, Financial Support
Regulation
Y
N
N/A
Comments
MHEC Approval/Waiver
Agency Approval
Certified Nursing Assistant Training Program - Resource Rev. 7/20/2016
Equal Opportunity
Employment Statement
Financial Support
.05: Faculty
Regulation
Y
N
N/A
Comments
RN MD License(s)
Resume (s)
Train The Trainer
Certificate(s)
Policy/Job Description/
Program Responsibilities
Supplemental Instructors
.06: Resources, Facilities, and Services: Description of
Regulation
Y
N
N/A
Comments
Education Facility
Clinical Facility
Clinical Site Approval
Facilities Written Agreement
Instructional Materials
.07: Training Program
Regulation
Y
N
N/A
Comments
Course Schedule
Curriculum Outline: 60/40
Ratio
CNA Role
Infection Control
Safety/Environment
Mobility/Positioning
Elimination
Data Collection
Hygiene
Treatments
Communication
Legal/Ethical
Core Knowledge & Skills,
example, math and English
pre-requisites
Course Schedule
100 Instructional Hours
Certified Nursing Assistant Training Program - Resource Rev. 7/20/2016
60/Didactic/16 Lab/40
Clinical Minimum
Role of CNA
Infection Control
Safety/Heimlich
Environment
Communication
Legal/Ethical
Total Number of Hours
.08: Evaluation
Regulation
Y
N
N/A
Comments
Evaluation Criteria
Final Exam
Skills Inventory
Skills Inventory: MD
Skills Listing Included
Achievement Award
Inventory of Requested Documents:
Instructions: To expedite the approval process, submit your Application to the Maryland Board of Nursing in the
following order.
Document
Y
N
N/A
Comments
Cover Letter
Approval Grid
Application Form
MHEC Approval/Waiver
Agency Approval Statement
Facility EOE Statement
Financial Support
Statement
Instructor Resume(s)
Train The Trainer
Certificate(s)
Copy of MD RN License(s)
Faculty JD/Policy
Responsibilities
Supplemental Instructors
Description of Education
Facility
Description of Clinical
Facility
Certified Nursing Assistant Training Program - Resource Rev. 7/20/2016
Facility Written Agreement
Description of Instructional
Resources
Curriculum With
Numbered Pages
Course Schedule
Skills Inventory
Policy/Statement
Re-evaluation Criteria
Final Examination
Achievement Award
