Fillable REQUIREMENTS FOR STATE CERTIFICATION EXAM (Modesto Junior College)

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REQUIREMENTS FOR STATE CERTIFICATION EXAM (Modesto Junior College)

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Rev. 5-27-2020 JM
MODESTO JUNIOR COLLEGE
ALLIED HEALTH and FAMILY & CONSUMER SCIENCE DIVISION
NURSE ASSISTANT TRAINING PROGRAM
STUDENT HANDBOOK
REQUIREMENTS FOR STATE CERTIFICATION EXAM
SOCIAL SECURITY CARD (not a copy) must have your signature
________By initialing this box, I understand that in order to complete the state exam I must provide an
original social security card, not copied or laminated.
DRIVERS LICENSE OR CALIFORNIA ID OR PASSPORT
_________By initialing this box, I also understand that in order to complete the state exam, if my
address has changed it must be updated on my government issued id. Or I must provide the DMV
issued change of address card.
CDPH 283B (not a copy)
WEAR UNIFORM (white nursing uniform top and navy blue nursing uniform pants)
BRING A PEN (Black ink)
WRIST WATCH WITH A SECOND HAND
Last Name
Signature
Date:
Semes
ter:
Y
ear:
First Name
Fall
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REQUIREMENTS FOR STATE CERTIFICATION EXAM (Modesto Junior College)

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Completed 5 January 2021

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