DIRECTIONS

APPLICATION [PDE-294] FOR GRADUATE/ STUDENT NURSES

Eligibility:

Graduate of state approved Professional or Practical Nursing School or

Student in state approved Professional or Practical Nursing School that has successfully
completed a clinical rotation and the subject material listed on the application and can be
evidenced with a grade or pass mark on your nursing school transcript.

Directions:
1. Complete Application form PDE-294. Be specific with your nursing courses.
The name and/or number of the course must correspond with your transcript.
Example: Basic Nursing Skills - Nsg 101 or Fundamentals of Nursing)
2. Complete Prohibitive Offenses form PDE-4382 E.
3. Attach a copy of transcript that has the name of school and your name imbedded on it. It
does not have to be an original transcript. A school web address from a computer print
out is acceptable.
4. Indicate name and address where the response should be sent.
5. Send original application and a copy to address below: Note: The signed application
becomes your letter of eligibility to register for the nurse aide examination.
Nurse Aide Program
Pennsylvania Department of Education
333 Market Street 11th Floor
Harrisburg, PA 17126-0333
Or fax to: 717-783-6672
Or e-mail to: ra-natcep@pa.gov
6. Retain a copy of application for your files. Allow 2-3 weeks for a response.
If you need any assistance, please call 717-772-0814 between the hours of 9:00 AM and
4:00 PM, Monday through Friday or e-mail us at ra-natcep@pa.gov
Career and Technical Education

Reviewed 8/2013

Pennsylvania Department of Education

NURSE AIDE PROGRAM APPLICATION
Graduate/ Student Nurse
This application determines eligibility to take the Nurse Aide Competency Examination.
Please type or print legibly:
Name_______________________________________________

Birth Date (MM/DD/YYYY) ________________

Address_____________________________________________

Telephone # (_____)_____________________

Education:
Name of Nursing School_________________________________________________________________________
Address______________________________________________________________________________________
Indicate on each line the specific name or number of the course in your nursing program in which the following
topics were taught and completed as evidenced on your transcript: (i.e. Nsg. 101; Fundamentals of Nursing)
Residents rights____________________________

Basic nursing skills_____________________________

Communication skills________________________

Personal care skills______________________________

Infection control____________________________

Basic restorative skills___________________________

Safety/emergency procedures__________________

Care of cognitively impaired______________________

Death/dying________________________________

Aging process__________________________________

Abuse Prevention____________________________

Course with Clinical Experience _________________

* Name & address of hospital or nursing home where you successfully completed clinical
____________________________________________________________________________________________
____________________________________________________________________________________________
ATTACH A COPY OF YOUR NURSING SCHOOL TRANSCRIPT

Signature of Applicant __________________________________________

Date_________________

Send completed application to:

Fax: 717-783-6672
E-mail: ra-natcep@pa.gov

Nurse Aide Program

Pennsylvania Department of Education
333 Market Street, 11th floor
Harrisburg, PA 17126-0333
State Use Only
APPROVED

NEED MORE INFORMATION

NOT APPROVED

Authorized Signature___________________________________________ Date___________________

PDE-294
Reviewed 8/2013

*******This is your letter of eligibility

Subject Material that must be successfully completed:

1. Residents Rights specifies how residents in long-term care facilities must be treated
this provides an ethical code of conduct for healthcare workers.
2. Communication Skills exchange of information verbally, written and nonverbally.
3. Infection Control set of methods used to control and prevent the spread of disease.
4. Safety/Emergency Procedures knowledge of common accident and how to prevent
them. Common emergencies and how to respond to them.
5. Abuse Prevention knowledge to identify, prevent and report abuse to provide quality
care.
6. Death/dying care of dying individual to meet all physical needs, as well as to provide
comfort and emotional support.
7. Basic Nursing Skills procedures to obtain information. (Such as vital signs.)
8. Personal Care Skills organized method to meet the needs of the individual in a longterm care facility. (Such as bathing, grooming, toileting, feeding and positioning.)
9. Basic Restorative Skills care used to maintain a residents function and increase
independence.
10. Care of Cognitively Impaired how to meet the needs of the individual that does not
have the ability to think clearly and logically.
11. Aging Process knowledge the normal changes that occur as the individual ages.
12. Clinical Experience provide name of course in your nursing program where you
successfully completed at least one clinical rotation. Also, provide the name and address
of the hospital or nursing home where you completed the clinical rotation.
Return application to:
Type or print Name legibly: _______________________________________________________
Address: _____________________________________________________________________
City: ________________________________________ State __________ Zip ____________
REMINDER:
(1) To register for the nurse aide competency examination, contact the American Red
Cross at 1- 800-795-2350.

(2) The approved, signed application must be attached to the student nurses registration
form for the Nurse Aide Competency Examination.
(3) All graduate and student nurses utilize the student nurse code 3959991 in section 4
Training Program Information on the registration form.
(4) All graduate and student nurses must take both the written and clinical skills
portion of the nurse aide competency examination.
PDE-294

Reviewed 8/2013

Pennsylvania Department of Education

PROHIBITIVE OFFENSES CONTAINED IN ACT 14 OF 1997
Nurse Aide Resident Abuse Prevention Training Act
Prohibitive Offenses
Acquisition of Controlled Substance by Fraud
Aggravated Assault
Aggravated Indecent Assault
Arson and related Offenses
Burglary
Causing or Aiding Suicide
Concealing Death of a Child
Corruption of Minors
Criminal Homicide
Dealing in Infant Children
Delivery by Practitioner
Designer Drugs
Drug Delivery resulting in Death
Endangering Welfare of a Child
Forgery
Illegal Sale of Non-Controlled Substance
Incest
Indecent Assault
Indecent Exposure
Intimidation of Witnesses or Victims
Involuntary Deviate Sexual Intercourse
Involuntary Manslaughter
Kidnapping
Library Theft
Murder I
Murder II
Murder III
Obscene and Other Sexual Materials
Obscene and Other Sexual Materials to Minors

Organized Retail Theft

Possession with Intent to Deliver
Promoting Prostitution
Rape
Receiving Stolen Property
Retail Theft
Retaliation Against Witness or Victim
Robbery
Securing Execution of Document by Deception
Sexual Abuse of Children
Sexual Assault
Statutory Sexual Assault
Theft
Theft by Deception
Theft by Extortion
Theft by Failure to Deposit
Theft From Motor Vehicle
Theft by Property Lost
Theft by Unlawful Taking
Theft of Leased Properties
Theft of Services
Theft of Trade Secrets
Theft of Unpublished Dramas or Musicals
Unauthorized Use of a Motor Vehicle
Unlawful Possession of Retail or Library Theft
Instruments
Unlawful Restraint
Unlawful Use of a Computer
Voluntary Manslaughter
*Any Felony Drug Conviction

Have you ever been convicted or entered a plea of guilty to any of the above offenses?
If yes, please submit a letter explaining the arrest, charges and final disposition.
If no, sign, date and submit with your application.
I understand that by submitting this completed form concerning Prohibitive Offenses to
the Pennsylvania Department of Education, I am certifying that all of the information I
have provided on this application is complete, accurate, true and correct. I make this
declaration subject to the penalties of 18 PA.C.S. 4904 relating to unsworn falsification to
authorities.
_____________________________________________ ________________________
Signature
Date
Reviewed 8/2013

Graduate and Student Nurses

Frequently Asked Questions (FAQ)

1. As a student nurse may I work as a nurse aide before taking the state nurse aide
competency examination?
You may work as a nurse aide in a nursing home for 120 calendar days without taking the
state nurse aide competency examination after your education has been evaluated and
approved by the Department of Education to meet the federal regulations.
2. As a graduate nurse that has not taken or has failed State Boards may I work as a nurse
aide without taking the state nurse aide competency examination?
The answer is the same as question number one.
3. How much of my nursing education do I have to complete before I can take the state nurse
aide competency examination?
You must have at least successfully completed one clinical rotation.
4. Do I have to complete a clinical rotation in a nursing home before I can take the state
nurse aide competency examination?
No, the clinical rotation can be in any health care facility.
5. Who do I contact to take the state nurse aide training competency examination?
You must first have your nursing education reviewed by the Department of Education
by the application can be downloaded by going to www.education.state.pa.us/nurseaide
scroll down and click on the PDE 294. A transcript from your nursing school must be
submitted with the application.
After the application is approved then you would contact the American Red Cross
at 1-800-795-2350 to register for the examination.
6. As a graduate or student nurse can I just take the written portion of the state nurse aide
competency examination?
No, the federal regulations require everyone to take both the written and clinical skills
portions of the state nurse aide competency examination.
7. Must I submit an official transcript with my application to the Department of Education?
No, the transcript does not have to be an official, but must have the name of the nursing
school and your name imprinted on the transcript.
Reviewed 8/2013

Graduate and Student Nurses

Frequently Asked Questions (FAQ) continued
8. To work in a hospital must I take the state nurse aide competency examination?
Not by federal regulations. However many hospitals will only hire individuals as nurse
aides after they have taken the state nurse aide competency examination.
The same is true for Home Health Agencies.
9. Where can I take the state nurse aide competency examination?
The American Red Cross will schedule you to the closest testing center by your zip
code.
10. What is the cost of the state nurse aide competency examination?
The state nurse aide competency examination costs $102.00.
11. Is there a study guide for the state nurse aide competency examination?
There is a practice written examination and a candidate handbook with the skills that
can be tested on the web site www.pearsonvue.com then click on Pennsylvania Nurse
Aides.
12. How many times may I take the state nurse aide competency examination?
You have three opportunities to take the state nurse aide competency examination.
13. May I continue to work as a nurse aide if I fail the state nurse aide competency
examination?
You may continue to work as a nurse aide in a nursing home for 120 calendar days from
the date of hire. If you have not passed the state nurse aide competency examination by
the 121 calendar day, you may not work as a nurse aide.
The nursing home may have you function as a non-hands-on worker; work in another
department or on a leave of absence until you pass the state nurse aide competency
examination.
14. What must I take to the testing center with me?
The information on what you must take with you to the testing center is in the candidate
handbook found on the web site www.pearsonvue.com then click on Pennsylvania Nurse
Aides.
Reviewed 8/2013