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Kentucky Health Care Training Institute

3010 Taylor Springs Drive
Louisville, KY 40220
Phone 502-458-4570
Fax 502-458-4240

Kentucky Medication Aide - Tuition Cost $855.00

The next available class is The class times are 8:00 a.m. to 1:00 p.m.

Enclosed is an application form for the class. If you are interested in the class, please call 502-458-4570 to set an appointment to enroll.

YOU MUST HAVE THE FOLLOWING WITH YOU AT TIME OF ENROLLMENT:

  1. A completed application including the signature of an employer who is verifying you have worked 6 months as a nurse aide in the last 2 years. Please have this completed before you come for your appointment.
  2. A copy of your high school diploma or transcript with graduation date or GED documentation.
  3. A letter from the Kentucky Board of Nursing stating you are currently on the Kentucky Nurse Aide Registry.
  4. A certificate of professional liability (malpractice) insurance (Minimum limits $1M/$3M). This may be purchased through an insurance agency or from Nurses Service Organization at 1-800-247-1500 or www.nso.com or fax # 1-800-739-8818. Apply for insurance as a student nurse or nurse aide- not student nurse aide.
  5. A Provider Memorandum of Agreement (MOA) must be completed and signed by either the DON or the Administrator of your long term care facility, agreeing to oversee your 40 hours of clinical training.
  6. Results of CURRENT 2 step TB test.
  7. Payment for the class - $855.00 tuition fee + $35.00 mandatory background report fee + $125.00 book fee + $55.00 Test Fee = $1070.00 PAYMENT BY PERSONAL CHECK OR CASH WILL NOT BE ACCEPTED. Payment may be made by money order, bank check or MC/VISA/DISCOVER CREDIT CARDS.

Kentucky Health Care Training Institute does not discriminate in employment or enrollment on the grounds of race, gender, color, age, national origin, sexual orientation, or disability.

Refund Policy - If a student cancels the class by 3:00 the Thursday before the class begins, $125.00 will be refunded. If the student does not cancel by 3:00 the Thursday before the class begins, the $50 no show fee will be deducted from the $125.00 refund. Once the student has attended any part of the class, there will be no refund.

There is an attendance policy in this class. If a student misses more than 6 hours, the student will be dropped from the class. The student must also maintain a 70% grade point average to complete the course. Class must be attended on the first day or the student will not be registered in that course.

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Kentucky Health Care Training Institute

KENTUCKY MEDICATION AIDE APPLICATION

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Name _____________________________________________________

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Mailing Address ___________________________________________________

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City, State, Zip Code _______________________________________________

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Telephone Number _____________ SSN __________________________

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Is the documentation verifying high school diploma or GED included with the application? �

YES� _________ � �� NO ____________

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Is CURRENT documentation verifying status on the Kentucky Nurse Aide Registry included with the application?

YES � ____________ �� NO� ____________

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Is proof of professional liability insurance included with the application? �

YES� _______ � NO ________

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Has above applicant been employed as a nurse aide in long-term care for at least 6 months in the last 2 years?�

YES� _____________ � NO � __________________

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THIS MUST BE SIGNED BY A REPRESENTATIVE OF A FACILITY IN WHICH THE APPLICANT HAS WORKED FOR 6 MONTHS AS A NURSE AIDE IN THE LAST 2 YEARS.

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_____________________________________ � � � � �� ____________

Signature and title of facility representative � � � � � � � �� � � � � � � � � Date � �

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PLEASE NOTE- ALL SPACES MUST BE COMPLETED. ANY QUESTIONS THAT HAVE BEEN ANSWERED ?NO? WILL RESULT IN THE APPLICATION BEING REJECTED.

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Refund Policy- If a student cancels the class by 3:00 the Thursday before the class begins, $125 will be refunded. If the student does not cancel by 3:00 the Thursday before the class begins, the $50 no show fee will be deducted from the refund. Once the student has attended any part of the class, there will be no refund.

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A student in the program is not allowed to miss more than 6 hours of class. If any more than 6 hours of class is missed, the student will be dropped from the course. The student may not miss any clinical hours. A grade point average of 70% and a grade of 70% on the final exam are required in order to complete the course.

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I certify that the information on this application is correct and complete to the best of my knowledge. I also understand the grade and attendance policy for this program and the refund policy as outlined above. I understand that I must be in uniform each day of the class.

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Signature of Applicant � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �Date