Doug Ducey Joey Ridenour
Governor Executive Director
Arizona State Board of Nursing
Request for Waiver
Nursing Assistant Certification Education
Military/Graduates of Foreign Nursing Programs
APPLICANT INFORMATION
I hereby certify that the information provided is true and correct. I also certify that I have read Nurse Practice Act Statutes
and Rules, ARS § 32-1645 and R-4-19-806 through R-4-19-815, and understand the qualifications and responsibilities of a
certified nursing assistant.
Signature of Applicant for Waiver
The following waivers apply for applicants that have not completed a Board approved nursing assistant training
program. Supporting documentation must be submitted along with the completed Request for Waiver form.
GRADUATES OF FOREIGN NURSING PROGRAM WAIVER
□ Graduates of foreign nursing programs, as evidenced by a copy of their diploma or foreign license.
MILITARY HEALTH CARE TRAINING WAIVER
□ Applicants who have completed at least 100 hours of military health care training, as evidenced by military
records, and have worked in health care within the past 2 years.
