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Knowledge Test Proctor (KTP) Agreement Application

BECOMING A KNOWLEDGE TEST PROCTOR (KTP): 
Please fill out this application if you are applying to be a Knowledge Test Proctor (KTP) who will administer the knowledge tests as a regular part of your test site duties with the TEST SITE named in this application at Iowa-approved testing facilities that meet D&S Diversified Technologies (D&SDT)-HEADMASTER requirements.

To qualify as a KTP, you must meet the following criteria:   
  • A KTP may NOT be an Iowa Nurse Aide Test Candidate who has not been tested. 
  • A KTP may NOT be a student in any Iowa Nurse Aide Training Program. 
You will attest 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 reference:
Once you have completed all the fields within this document, select 'Send Application' to submit your application.
Address
RN License Information
TEST SITE INFORMATION
Affidavit
TEST SITE ACKNOWLEDGEMENT:
  • I certify that I am working as a knowledge test proctor (KTP) for the test site named in this application.
  • I understand that I will administer the knowledge tests as a regular part of my duties with the test site named in this application, with no compensation from D&SDT-HEADMASTER.
CONFIDENTIALITY/NONDISCLOSURE AGREEMENT:
I acknowledge the confidential nature of the Iowa knowledge exam. This includes the materials, processes, procedures, and content of the knowledge examination.
  • I agree to safeguard the confidentiality of all information about the Iowa knowledge exam.
  • 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 candidate's performance with instructors or administrators of any training facility, program, or with anyone else other than D&SDT-HEADMASTER staff, or the appropriate State agency.  
  • I will not administer tests to test candidates who work within the same company or whom I have trained, or to family members or 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 am 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 facility administrator examination by calling the D&SDT-HEADMASTER home office at (800) 393-8664.
By Submitting
I hereby verify that I understand and agree with the statements contained herein and the above information is true and correct.
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