Application for DD Personnel to Attend the DODD Medication Administration (MA) Certification Course
Prior to DODD Medication Administration Certification (Initial Certification class or Renewal): DD Personnel must submit a completed application to the RN Trainer, including all Employer and Personal information and signatures. DD Personnel whose application forms are not completed or without required signatures are not eligible for DODD Medication Administration certification.
If you are a DODD Certified Independent Provider, for the purposes of this application, you are the employer
Work Location: At the time of this application, where does this person primarily provide services or supervision?
(If no direct phone or email at location, list DD employer agency phone and email)
Prior to attending a DODD MA Certification Course:
all information and signatures. Without a completed application DD Personnel will not be eligible for DODD Medication Administration certification to administer medications.
I attest that all information provided on this application is true, current and correct.