Submit New Application

CNA Knowledge Exam Observer Affidavit and Confidentiality/Nondisclosure Agreement Application

To be test proctor, you must review and be trained with the KTP Training Guidelines by a certified Test Observer.  

Once you have completed all the fields within this document, select 'Send Application' to submit your application. 
Contact southdakota@hdmaster.com with questions.
Address
RN License Information
Affidavit
As a Knowledge Test Proctor (KTP), I swear that I have reviewed the Proctor Training Guidelines with the Test Observer named, I understand and will abide by the approved material presented. Click to open:  Link to Training Guide.
  • I understand that as a proctor, I will not be permitted to apply and take the South Dakota Nurse Aide exam for six months from the date that I last worked as a proctor.
CONFIDENTIALITY/NONDISCLOSURE AGREEMENT:
I acknowledge the confidential nature of the nursing assistant competency examination. This includes the materials, processes, procedures, and content of the examination's knowledge and manual skills portions.
  •  I agree to safeguard the confidentiality of all information about the nursing assistant competency examination.
  •  I will not disclose any portion of the examination materials.
  •  I will not disclose the processes or procedures necessary to administer or pass the examination, nor will I disclose any test content, examination results, or information about any Nurse Aide candidate's performance with instructors or administrators of any training facility, program, or with anyone else other than the Test Observer, D&SDT-HEADMASTER staff, or the Board.  
  • I will not be involved in testing family members or close personal friends, except in emergency situations as provided for in the D&SDT-HEADMASTER and State Guidelines.
TEST SECURITY: 
I will maintain and never violate the tests' security or compromise any testing information. I understand that if I violate test security, I will be held legally accountable and prosecuted to the full extent of the law.
By Submitting
I hereby verify that I understand and agree with the statements contained herein and the above information is true and correct.
Application Fee $40.00
Non-Refundable. All fees are non-refundable.
We accept Visa and Mastercard.
Files are uploading, please wait...