Account Applications Create

Please fill out this application and attach the following documentation:

W-9 (with your business name and Federal Tax ID number on it - remember to sign it; there has to be a wet signature.) Click here to open the W-9 form
Direct Deposit Form must include a voided check or bank letter (to electronically process successfully completed testing payments from D&SDT to you). Click here to open the Direct Deposit Form.
- Note this does not have to be a business bank account; we can electronically deposit your testing payments into any bank account.

There is a non-refundable one-time fee of forty dollars ($40.00) to certify that you have the necessary qualifications to administer exams that meet State testing standards. Please complete the credit/debit card certification fee payment information when you submit this application.

You will attest in the Affidavit at the end of this document that you have read, understand, and will abide by the following documents. Please print these documents and keep them for your records.

Click to open: TEST ADMINISTRATION SERVICES (TASE) AGREEMENT

If you are an IACC, the following charges from the 1505 are not applicable:

A one-time fee of forty dollars (*$40.00 per initial Knowledge Test Observer)
Twenty-five dollars ($25.00) yearly for review and oversight per State-approved processes.
Twenty-five dollars ($25.00) per fifteen minutes of COMPANY staff time needed to correct erroneous or disorganized test administration materials submitted for official scoring to COMPANY by Contractor’s test team(s).

Once you have completed all of the fields and uploaded the required documents within this application, select 'Send Application' to submit your application.

CONFIDENTIALITY/NONDISCLOSURE:
I acknowledge the confidential nature of the nursing assistant competency examination, including the materials, processes, procedures, and content of the 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.
I will not disclose any examination results to instructors or administrators of any training facility or program.
I will not test or be involved in testing students I have trained or had professional contact with during training, family members, or close personal friends.

I understand that this agreement extends to and includes, but is not limited to, allowing unauthorized persons to hear, view, videotape, or otherwise obtain any knowledge of the exam before, during, or after its administration. I recognize that disclosing or revealing, or allowing this information to be disclosed or revealed, constitutes a violation of this agreement and could place my nursing license at risk and/or be subject to prosecution to the full extent of the law and/or a $100,000 fine. I agree to immediately report any known or suspected security breach related to the nurse aide competency examination by calling the D&SDT-HEADMASTER home office at (800) 393-8664.

TEST ADMINISTRATION SERVICES (TASE) AGREEMENT: (Keep a copy of this agreement for your records.)
I hereby certify that I have read, understand, and will abide by the terms and conditions of the Testing Services Business Entity Agreement Form (1505 TASE) as established by statute in the State of Iowa to do business.

I understand that I must pay a non-refundable one-time fee of forty dollars ($40.00) to certify that I have the necessary qualifications to administer exams that meet State testing standards.

I have uploaded the required documentation with this application, which includes:

Signed (with a wet signature) W-9 Form with my business name and Federal Tax ID
Direct Deposit Form with a voided check or bank letter

Submit New Application

Test Administration Services Entity (TASE) Application