Submit New Application

Instructor Login Application

Complete this form and submit it. Once approved, you will receive a login to OH MA-C TMU where you can enter and complete MA-C students which will allow them to register and take the MA-C state competency exams.

Legal First Name

Middle

Legal Last Name

Birthdate

Phone

SSN

Gender

Male Female Other

Address

City

State

Zipcode

RN License Information

License Number

Expires

Training Program Affiliation Please enter the name of the training program where you are an instructor.

Affidavit

I attest that by completing this application:

I am an active RN and
I have met the requirements of a OH MA-C nurse aide instructor and can enter and certify completion of training of medication aide candidates (as per Ohio Board of Nursing requirements for approval of a medication aide training and competency evaluation program).

By Submitting

I hereby verify that I understand and agree with the statements contained herein and the above information is true and correct.